Sunday, 10 July 2016

Unwanted childbearing: a huge concern for India

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

Happy World Population Day 2016

From Adam Smith onward, economists have recognized important linkages between population and socio-economic development. Yet, the attention given to these linkages in current development thinking in India is not very clear. This is because one can argue that it is not rapid population growth but rather weak government, corruption and social injustices that are preventing economic and social development. The counter argument is that rapid population growth exacerbates the problems of governance, corruption and social injustice. However, one has to recognize that population is an important factor in development, especially when it is growing seemingly out of control since it leads to a significant diversion of national investable resources to consumption which could otherwise be used for increasing investment and productivity and for improving the quality of public services such as education, health, sanitation, provision of safe drinking water, etc.  

With 1.27 billion or 127 crore 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 3-4 years. Many Indians including policy makers see these emerging demographics as a critical advantage in competition with 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. It is not enough to have lots of young people — these young people need to be properly educated to fully contribute to the economy. Today, more children are going to school but what they are learning is not clear.

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.

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. In addition, it is estimated that currently there are around 460 million people out of 1270 million in India who are product of unintended/unplanned pregnancies, and most of them are from the lower economic strata. The consequences of unwanted fertility are serious, slowing down the process of socio-economic development. While India’s population continues to grow by 17-18 million people annually, 15 million married women in the reproductive ages, mostly in the 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.   Approximately two-thirds of such pregnancies resulted from non-use of contraceptives; clearly indicating the need for easy availability of quality family planning services. The program has largely failed to encourage the use of reversible methods, particularly among young women (15-25) who are in the most fertile years of their reproductive period. In addition, around one-third of unintended pregnancies resulted from the ineffective use of contraceptives, which suggests the need for improved counseling and follow-up of couples that adopt a method. In other words, there is a tremendous need to revamp the family planning program in India 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 galloping population issue under relatively low literacy and high poverty, there is no reason why FLNI States, with lesser problems and with increasingly generous support from the Centre 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.

For further details, see: Kothari, Devendra and Sudha Tewari. 2009. Slowing Population Growth in India: Challenges, Opportunities and the Way Forward. MIPD Policy Brief No. 2, Management Institute of Population and Development, (Parivar Seva Sanstha, New Delhi). Also see Blog: for articles on population and development.