Wednesday, 17 July 2013

Managing unwanted fertility – India’s priority # one

Dr. Devendra Kothari
Population and Development Analyst,
Forum for Population Action

The problem of unwanted fertility is extremely serious considering India’s pressing economic and social scenarios.

The World Population Day, annually observed on July 11, is an occasion to engage people, spur commitment and spark actions related to the opportunities and challenges presented by the growing population.

With 1.27 billion (2013) people and still growing, India is getting dangerously overcrowded. India is currently the second most populous nation in the world. It will surpass China as the most populous within 8-10 years. Its population is projected to peak at 1.65 billion in 2065. China at its peak in 2030 will have 1.45 billion people. In fact, when China peaks, India will have already surpassed it in population (UN World Population Prospects, 2012). Many Indians see these emerging demographics as a critical advantage in competition with the nation it regards   as its chief rival – China. With around 70% of the population under 35, India can afford to dream to become economic power in the world before the middle of this century. However underneath, this rosy outlook for India epitomizing the country’s ability to surpass China on the back of a younger population lays some difficulties, especially deteriorating level of education and nutrition. It is not enough to have lots of young people — these young people need to be properly educated/skilled to fully contribute to the economy. Today, more children are going to school but what they are learning is not clear. The Annual Status of Education Report 2012 by Pratham shows that the number of Class V students who could not read a Class II level text or solve a simple arithmetic problem has increased. In 2010, 46.3% of children in this category failed to make the cut and this shot up to 51.8% in 2011 and 53.2% in 2012. Can they get any job in the market if they continue such education? Can industry get the professionals it is looking for?[1]

Current population growth is mainly fueled by unwanted fertility. More than four in ten pregnancies are unintended by the women who experience them, and half or more of these pregnancies result in births that spur continued population growth. Around 26.5 million children were born in the year 2012 and out of this almost 6.0 million pregnancies had been classified as unplanned. The government has to spend on an average around Rs. 8760 per year to raise a child until the age of 15. By avoiding unwanted pregnancies, the government would have saved at least around Rs. 52560 million in that year alone. Further, it is estimated that currently there are around 460 million people out of 1270 million in India in 2013 that are product of unplanned pregnancies, and most of them are from the lower economic strata (based on the findings of National Family Health Surveys). The consequences of unwanted fertility are serious, slowing down the process of socio-economic development. It is because unwanted childbearing results in poor physical growth, reduced school performance, diminished   concentration in daily tasks thus impacting work capacity and work output resulting in diminished earning capacity. The impact of this is reflected in widespread hunger, malnutrition, poverty, unemployment, weak governance as well as increasing scarcity of basic resources like food, water and space in several parts of India despite concerted developmental efforts since 1991. [2]

How to mange unwanted fertility? A popularly held belief by India’s policy makers is that as a country becomes economically more prosperous, its fertility declines significantly and leads to a stable population. However, this is a simplistic view of a complex phenomenon.  Since the introduction of market-based economic reforms in 1991, India has become one of the fasted growing major economies in the world. The reforms completed 20 years in July 2011, however, during this period, India’s population increased by 365 million, much more than the population of USA - the third most populous country in the world.  This raises the question: Is Development the Best Contraceptive or Are Contraceptives?  It is argued that there is a need to go beyond the prevailing notion that socio-economic development is an essential precondition for fertility transition, since it provided only a partial explanation for the monumental changes taking place in fertility behavior, especially in low-income economies like Bangladesh and Andhra Pradesh.[3]

More than four in ten pregnancies are unintended by the women who experience them, and half or more of these pregnancies result in births that spur continued population growth. While India’s population continues to grow by 17-18 million annually, 15 million married women in the reproductive ages, mostly in Four Large North Indian (FLNI) States of Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh, seek to postpone childbearing, space births, or stop having children, but are not using a modern method of contraception that is having unmet need for family planning services. Often, these women travel far from their communities to reach a government health facility, only to return home “empty handed” due to shortages, stock outs, lack of choices and/or non availability of doctors and paramedical staff. When women are thus turned away, they are unable to protect themselves from unwanted pregnancies. Rural Development Minister Jairam Ramesh candidly admitted that in many parts of India, public health system does not exist. “We all know that the health system in India has collapsed”, he added. Today, the single most important measure to manage unwanted fertility is to revamp the public health system to provide services looking to the needs of clients.

Incidence of unintended frequencies can be dramatically reduced, if not eliminated, within a decade by revamping family planning program,   as has been done in Andhra Pradesh.  If Andhra - with little outside help - can manage its population issue under relatively low literacy and high poverty, there is no reason why Four Large North Indian States, with lesser problems and with increasingly generous support from the Government of India under National Rural Health Mission (NRHM), should fail so spectacularly in managing unwanted fertility.

It appears that the population and related issues have not been given due importance in the development debate of India. Demography, therefore, in the next 10 years or so will pose serious challenges to economic growth, democracy and national unity by its sheer size. The writing is on wall. The question is not whether we act or not, but whether we act now or later and deal with much more dire and expensive consequences. Hope India’s political landscape which suddenly has energetic younger leaders will take it seriously and lead the way.[4]

[1] Refer: Kothari Devendra, “Galloping population, a huge concern”, One India One People, July 2013.

[2] Refer: post by the author: Food Security Bill and malnutrition in India, dated June 30, 2013 at link:

[3] Kothari, Devendra and S.  Krishnaswamy. 2003. “Poverty, Family Planning and Fertility vis-a vis Management of Family Planning Services in India: A Case Study”. In Maria Eugenia COSIO-ZAVALA (Ed.). Poverty, Fertility and Family Planning, Paris: CICRED, 335-58.

[4] The term younger is a flexible one, ranging from Akhilesh Yadav and Rahul Gandhi in their early 40s, Shivraj Singh Chauhan, Vashundhra Raje, Mayawati in their 50s, and Nitesh Kumar  and Narendra Modi in their early 60s.