If Modi govt wants to control population, it must target high fertility rates in these states

Challenge for India lies in how it can effectively chart a unique path in ensuring sustainable and equitable development for its billion-plus people.

Representational image | Mitesh Bhuvad | PTI

Prime Minister Narendra Modi’s concerns over population explosion are warranted. Even if fertility in India were to immediately drop to replacement levels, India is still projected to add over 185 million or 18.5 crore people between 2019 and 2050.

There is no historical precedence for modern democratic governments, which uphold individual liberties, to equitably and effectively provide for a billion-plus population. While China’s experience is inevitably invoked in conversations on population size, the country’s unique political regime and coercive policies offer no feasible knowledge transfer to the democratic set-up in India.

The challenge for India lies in how it can effectively chart its unique path in ensuring sustainable and equitable development for its billion-plus people.

Large population, limited resource

PM Narendra Modi’s call for population control in his Independence Day speech came in the backdrop of a consistent decline in national fertility in India, from a Total Fertility Rate (TFR) of 4.97 in the 1970s to 3.2 in 2000 to a near-replacement fertility of 2.2 in 2017. (Total Fertility Rate refers to the total number of children born or likely to be born to a woman in her lifetime if she were subject to the prevailing rate of age-specific fertility in the population.)

And yet, with a current population of 1.37 billion or 137 crore, India is set to overthrow China as the world’s most populous country by 2027.

Concerns of population sizes outstripping the limited global resources are not new. First articulated by Thomas Malthus in 1798, these ideas have found voice throughout history. However, their critics have prevailed for the most part. Accelerated economic development through technological progress, increased productivity and improved standards of living meant Malthusian doomsday predictions never reached fruition.

By the end of the 20^th century, there was a notable shift in the lexicon of population policy, from “population control” to “family planning” to “reproductive and gender rights”. Giving salience to the principle of individual choice in reproductive decisions was key to this transition. It appears that on matters of family size, societies, with the exception of China, have overwhelmingly leaned in favour of individuals over the state.

State has a role to play

Given India’s own experience with forced sterilisation in 1975, there is no doubt that any future population policy should continue to ensure and accelerate free will, particularly that of women. This does not imply that the state is a silent spectator. Rather its role is seen to create conditions, which could implicitly or explicitly influence individuals’ behaviour towards the desired goal of “smaller” families.

Of these ‘conditions’, a clear one is to influence the age at which a woman gets married. Increasing the age of marriage (and by extension, delaying the likelihood of having a child), along with birth spacing and prolonged postpartum infertility are critical determinants of natural fertility.

Other – more control-based – strategies to avoid pregnancy that appear to work include improved access and incentivisation of contraception, and access to abortion. A 2014 study based on six Asian countries including India, Bangladesh, Nepal, Philippines, Indonesia and Vietnam found access to contraceptives and increase in the marital age to be the most important determinants of controlled and natural fertility. Indeed, these specific factors operate within, and are influenced by, the broader social and economic factors, such as education of girls and employment of women, urbanisation, improved job opportunities and increases in family incomes.

The good news is that India is steadily making progress on these socio-economic determinants, but improvements are highly uneven across India.

Decoding the data

Even as national fertility has been declining steadily, states like Bihar (3.2), Uttar Pradesh (3), Madhya Pradesh (2.7), Rajasthan (2.6), Jharkhand (2.5), Chhattisgarh (2.4) – which together account for nearly half of India’s population (48 per cent) – continue to have very high fertility rates. Meanwhile, states like Kerala (1.7), Karnataka (1.7), Maharashtra (1.7), Tamil Nadu (1.6), West Bengal (1.6) are now well below replacement fertility, mirroring the levels in countries like France (1.85), Iceland (1.77) and Norway (1.68), according to United Nation’s latest revised estimates in 2019.

Any future family planning in India has to effectively locate itself within the broader socio-economic factors and target the high TFR states. An obvious way is to ensure effective implementation of legislation on the age of marriage of women. Child marriage continues to be an important concern in all states reporting high fertility.

National Family Health Survey (NFHS) data shows that states with high fertility still have very high proportions of women marrying before the legal age. Forty-two per cent women in Bihar, 38 per cent in Jharkhand and one-third of the women in Rajasthan and Madhya Pradesh marry before the age of 18. In these states, keeping girls in schools is intrinsically linked to marriage and fertility trends.

NFHS data shows that 20 per cent of women with no schooling begin childbearing at 15-19 years, against 4 per cent of women with at least 12 years of schooling. Women with no schooling have a lifetime fertility rate of 3.1, against 1.7 for women who complete schooling. Targeting female literacy, absenteeism and school dropout rates in states with high fertility is critically important.

NFHS data reveals that against a 6 per cent national unmet need for spacing among women aged 15-49 years, Bihar’s stands at 20 per cent and Uttar Pradesh’s at 18 per cent. Against 54 per cent women at a national level, only 20 per cent women in Bihar use any contraceptive method. Continued investment in effective campaigns to educate women on birth spacing and post-partum infecundability, and improved access and incentivisation of locally accepted scientific means of contraception in these states are needed.

Don’t blame poor, don’t burden women

We hasten to add that any public policy approach should be highly cognisant of not “blaming the poor”. Leaving aside the vexing issue of which one causes which, poverty and high fertility share a strong correlation. Fertility rates of women in the lowest wealth quintile is 3.2 against 1.5 for women in the highest wealth quintile. Only 3 per cent of teenaged women in the top 20 per cent of the wealth index begin childbearing in contrast to 11 per cent in the bottom 40 per cent.

Rhetoric-heavy public statements that conflate family size with “patriotism” or “nationalism” are unwarranted, and unfairly, even if unintended, ‘blame the poor’.

A course-correction is also needed in not placing the responsibility of family planning solely on women, inadvertently or otherwise.

Consider sterilisation. Female sterilisation has continued to far surpass male sterilisation in India. A recent 2017-18 report from the National Health Mission found that 93.1 per cent of all sterilisation procedures were performed on women. Female sterilisation has also been the most common contraceptive method for married couples. Among currently married women, NFHS data shows, 36 per cent use female sterilisation, followed by male condoms (6 per cent) and pills (4 per cent). It is time for public policy on family planning to actively promote principles of collective action and shared responsibilities.

Go beyond numbers

Population policy cannot be a matter of numbers alone, even when, on occasion, the ‘numbers’ may be desirable.

For instance, India’s largely young population is often seen as a potential force that can power the country’s economic engine. At the same time, concerns over environmental sustainability of conventional economic development strategies are becoming increasingly urgent.

In this context, it is worth recalling Mahatma Gandhi’s discerning words that “the world has enough for everyone’s need, not everyone’s greed”.

Pritha Chatterjee is a PhD student in population health sciences at Harvard University. S.V. Subramanian is Professor of Population Health and Geography at Harvard University. Views are personal.