The population control mirage

India’s population was about 350 million during Independence. It crossed the one billion mark in May 2000 with 1.3 billion inhabitants.

By 2024, India would become the world’s most populous country surpassing China. India accounts for 18 per cent of the global population with just 2.4 per cent of the land area.

A significant fall in growth rates in empowered action group (EAG) and non-EAG states during the decade of 2001-2011 has contributed to a decline in population explosion. EAG states include Bihar, Chhattisgarh, Jharkhand, MP, Odisha, Rajasthan, Uttarakhand and UP.

Trends in crude birth rate (CBR) show that there has been a drop of 15 percentage points during the last 40-year period, but it is still high at 21.4 per 1,000 live births. 

The total fertility rate (TFR), the number of births per woman stands at 2. 2 (NFHS, 2015-16). The differentials are pegged at urban (1.8) and rural (2.4). TFR continues to be above the national average in EAG states. 

Higher order births account for 1/4 of total births, which could be brought down by the use of contraception. Contraceptive prevalence rate (CPR) has risen over the last 23 years, but the 0.5 per cent increase is meagre. 

What is deficit in the current contraceptive rates? The programme targets women and female sterilisation is predominant. Unmet need for contraception is still large in high fertility states. Child mortality, though half, continues to be higher than the national average in EAG states. This again, continues to lag far behind laid down goals.  

Marriage continues to be both early and nearly universal; about 22 per cent women marry before 18. Roughly, four out of 10 women in Bihar, Rajasthan and MP marry before the legal age. More stringent enforcement of the Marriage Act is needed.    

India launched its official family planning (FP) programme in 1952, which emphasised on reducing birth rates and stabilising population. Contraceptive services were provided free of cost, but its use did not pick up for nearly two decades. 

During the 1960s, due to unprecedented population growth, the government began programmes to lower birth rate from 41 to 20-25 in the mid-1970s. 

However, a crude birth rate of 25 was attained only by 2002, after 30 years.  As per the latest available sample registration system (SRS) estimates, CBR is 20.4. The goal set for 1970s has been achieved after 45 years.

The National Population Policy (NPP) was announced in 1976 and intensified during the Emergency. Though the sterilisation performance increased, there were complaints of coercion that resulted in a setback to the FP programme. It recovered after 1980 when it was implemented through state governments with financial assistance from the Centre.   

During 1981, India’s TFR of 4.5 declined to 3.2 in 2000. However, the goal remained unachieved. By early 1990s, fertility declined in India and a substantial fall was observed, attributable to moderate success of the FP programme.  

The National Population Policy, 2000, aimed at addressing unmet needs, bringing down TFR from 3.2 in 2000 to 2.3 in 2013.

The country is behind the goal laid down by the NPP even in 2016, as evident from the NFHS-4 estimates of 2.2.

Urban India has already achieved replacement level fertility while TFR for rural India continues to stand at 2.4.  

The National Rural Health Mission (NRHM) launched in April 2005, attempted to bring down TFR to 2.1 by 2012, which again, remained unachieved. NPP, 2017, aims at bringing down the TFR to 2.1 at national and sub-national levels by 2025.

However, it is unlikely that states like Bihar, UP, MP and Rajasthan would achieve the goal, given the current prevailing rates. 

Most policy and programmes seem to have set optimistic demographic goals that have failed to enthuse. 

Goals remain unrealised. TFR can be brought down quickly up to a certain level, beyond which it requires changes in desired family size that can be achieved only through significant social transformation and change in gender relations. 

This holds true in the case of the northern states where there is a strong son preference.  Women’s education is again widely regarded as an important factor in fertility decline.  

Interestingly, institutional deliveries have increased substantially after the introduction of Janani Suraksha Yojana (JSY).  However, the large window of opportunity offered by the significant increase in institutional delivery under JSY has not been reflected in the uptake of contraceptive services, showing a lack of integration between FP and Maternal and Child Health (MCH) services.

Even though contraceptive use has increased and the small family norm is widely accepted, the existence of huge unmet needs in EAG states points towards deficiency in services.   There is still a large population, which is either not accessing or not accepting contraception for limiting family size. The contraceptive scenario is characterised by the predominance of non-reversible methods, particularly female sterilisation and limited use of spacing methods. 

Contraceptive use for delaying and spacing is still minimal. The large window of opportunity offered by the JSY scheme needs to be effectively tapped for promotion and uptake of postpartum contraception. Hence, what is of prime importance is how effectively high fertility states implement reproductive and child health (RCH) programmes during the next seven years. 

Special attention needs to be focused on poor performing states and high priority districts. If necessary, there is a need to shift approaches towards area specific interventions rather than universalisation of schemes.

It is vital for expanding and exploring alternative models under the public-private partnership (PPP), as well as increasing the available basket of choices.

Author is with the Public Health Foundation of India. Views expressed are personal