Wednesday, 30 September 2020

Declining Hindu and Muslim fertility gap: what is it pointing?

 

Dr. Devendra Kothari

Population and Development Analyst

Forum for Population Action


If the economy is allowed to develop unimpeded, the Hindu-Muslim population issue must be discussed thoroughly.

 

Differential population growth and fertility rates by religion are a major political issue in India. There is a widespread feeling that the main cause of population explosion in India is the   higher fertility among Muslims as compared to other religious groups, especially Hindus. Further, it is often argued that the growing demographic imbalances in India should indeed be a matter of serious concern as they seem to have serious repercussions on the very survival of the ‘Indian civilisation’. 

Whether we agree or not, I strongly believe that unless we resolve a far-flung impression that Muslims are responsible for India's population explosion, it will have serious implications for socio-economic development by creating unnecessary tensions. In addition, it will affect everything from efforts toward a uniform civil code to the debate about religious conversions to assumptions about Indian secularism.   A national debate, therefore, is urgently called for to step up to resolve the issue. This article aims in this direction.

 

Population explosion is an age-old issue in India, but it has gained traction once again after Prime Minister Narendra Modi mentioned it in his Independence Day speech (2019). PM Modi, known to generally celebrate India’s “demographic dividend”, expressed concern at a “betahasa jansankhya bisfot” (reckless population explosion) and stressed the need for government action to control the situation. The announcement drew mixed reactions. The Congress leader P. Chidambaram cheered it. On the other hand, some BJP leaders sniffed in the announcement a signal of the government’s intention to enact some kind of legislation to control the Muslim population.  The BJP and RSS leaders have for years been blaming Muslims for the purported spurt in the country’s population and raising the bogey of the community eventually outnumbering Hindus in the country.[1] In fact, a few politicians from the ruling party have used the PM speech to exhort Hindu women to birth at least four children.

 

But, based on the official data, this narrative does not hold water. The National Family Health Survey (NFHS) has shown that over the past 24 years, new-generation Muslim families have done a better job at family planning, though their statistical figures still trail Hindu families.

The decadal census is the largest data collection exercise carried out by the government to assess not only the growth of the population but also other socio-economic indicators. The 2011 Census of India was the 15th in a series of censuses held in India every decade since the first complete census was taken in 1881.The next Census of India, the 16th Indian Census, was to be taken in 2021. It has, however, been delayed due to the COVID-19 pandemic. 

In the absence of the latest information, the author has projected the data for the decade 2011-21 based on the various sources with special reference to the National Family Health Survey-4 (2015-16).  The NFHS is a large-scale multi-round survey conducted in a representative sample of households throughout India under the guidance of the Ministry of Health and Family Welfare, GoI. The primary aim of the NFHS has been to provide information on maternal and child health and reproductive health. Four rounds of the NFHS were conducted in 1992-93, 2005-06, 1998-99 and 2015-16. 

Let us consider some plain facts: 

Will Muslims outnumber Hindus in India in the near future? The Census 2011 data shows that since the census 1951, the share of Hindus has dropped by 4.3 percentage points from 84.1 per cent to 79.8 per cent of the total population in 2011 while the share of Muslims has risen by 4.4 percentage points from 9.8 per cent (no Census was conducted in the JK in 1951) to 14.2 per cent in the corresponding period. Hindus comprised just about 66 per cent of the population of India before partition in 1947. It is interesting to note that the projected figure shows a slight increase in the share of Hindu Population in 2021 as compared to 2011: 80.3 per cent versus 79.80 per cent.  The data from the NFHS-4 also collaborated this trend (refer last row of Table 1) 

Table 1 Trends in Population of India by religion – 2051-2021

Religion

Hinduism

Islam

Christianity

Sikhism

Jainism

others

1951

84.10

9.80

2.30

1.79

0.45

1.86

1961

83.45

10.69

2.44

1.79

0.46

1.17

1971

82.73

11.21

2.60

1.89

0.48

1.12

1981

82.30

11.75

2.44

1.92

0.47

1.12

1991

81.53

12.61

2.32

1.94

0.40

1.20

2001

80.46

13.43

2.34

1.87

0.41

1.55

2011

79.80

14.23

2.30

1.72

0.37

1.51

*2021 (projected)

80.30

14.61

2.25

1.63

0.36

0.85

% of total  households NFHS-4 (2015-16)

81.4

12.5

2.7

1.6

0.2

1.6

*Projected figures for the year 2021 are based on various sources like. NFHS-4 (2015-16), Population Reference Bureau and United National Population Division. Also refer: The Future Population of India, Population Foundation of India, New Delhi (2007). Devendra Kothari (2011) Implications of Emerging Demographic Scenario, A Brief, MIPD, Parivar Seva Sanstha, New Delhi.

Source: Census of India, and National Family Health Survey-4 (2015-16)



In absolute terms, the Hindu population has increased more than three times from 304 million in 1951 to 966 million during the last 60 years till 2011. On the other hand, during the corresponding period, the Muslim population increased from 34 million in 1951 to 172 million in 2011 that are more than five times (Table 2).

 

The drop in share of Hindus, due to a steady dip in the rate of growth of the Hindu population, comes on the back of rising education and income levels of the majority community

 

 Table 2   Absolute population increase in million by religion, 2001-2021

Religion

Census 1951

Census 2001

Census 2011

Projected 2021*

Hindu

303.6

828.3

965.6

1117.0

Muslim

34.4

137.9

171.8

203.1

Christian

8.3

23.7

27.8

30.6

Sikh

6.5

19.6

20.6

20.8

Buddhist

2.8

8.2

8.5

8.3

Jain

1.6

4.1

4.8

5.2

Others

3.8

7.2

10.9

6.0

Total

361

1029

1210

1391

Source: Table 1

As such, there is a sense of paranoia that if the Muslim population is allowed to increase   it will overtake the population of Hindus in coming years. Before we resolve the issue, let us discuss what has happened in the first decade of 21st century. Before the Union Home Ministry released Census 2011 data on Population by Religious Communities on 21 Jan, 2015, it was widely believed that the data would point to a significant growth in Muslim population in India, which really forced the UPA to postpone its publication. However, the population growth rate of various religions has come down in the decade (2001-2011). Hindu population growth rate slowed down to 16.76  per cent from previous decade figure of 19.92 per cent while Muslim witness sharp fall in growth rate to 24.60 per cent in 2001-2011 from the previous figure of 29.52   per cent (Table 3). Such an abrupt fall in population growth rate for Muslims didn't happen in the last 6 decades. This was a positive outcome of the Census 2011, which nobody has taken seriously.

The Growth rate of Hindus, Muslims and Christian is expected to fall further in the upcoming 2021 census while other religions like Sikhism, Jainism and Buddhism are expected to remain stable for next 2 decades considering the already slowed down growth rate of these religions. In fact, in absolute numbers, the Jain population may decline. 

According to the projected figures the Hindu population growth rate will go down further to 15.7 per cent from previous decade figure of 16.8 per cent while the Muslim population   may witness another sharp fall in growth rate to 18.2 per cent from the previous figure of 24.60 per cent, as shown in Table 3. One can notice difference between Hindu and Muslim population is narrowing fast. I believe that gap will further decrease in the Census 2031. 

  Table 3 Hindus versus Muslims: Trends in decadal population growth

Year

Trends in decadal population growth  in percentage

Year

Muslim

Hindu

Difference

1981-1991

32.9

22.8

10.1

1991-2001

29.3

20.0

9.3

2001-2011

24.6

16.8

7.8

2011-2021 (Projected)

18.2

15.7

2.5

Source: Census of India. Also  see footnote of Table 1

So there is no sense of talking that Muslims will overtake Hindus, as argued by the many right wing politicians. Minorities in India, much like in the United States, are not really anywhere close to being dominant and the fear of any “Muslim takeover in India” was baseless, as noted by the 2019 Economics Nobel-winner Abhijit Banerjee. [2]  

Now there is a big question why the Muslim population is growing slowly? There are many factors behind this unexpected trend but two factors are very important: Emerging middle class and declining fertility.

 

The National Family Health Survey (NFHS) has shown that over the past 24 years, new-generation Muslim families have done a better job at family planning, though their statistical figures still trail the Hindu families. 

In India, a small, emerging yet visible Muslim middle class has surfaced, “breaking the perception of a monolithic impoverished community”, as noted by Ashwaq Masoodi, the Nirman Fellow at Harvard University.[3] For example, the NFHS-4 shows that even though, among all religions, the presence of Muslims in the highest wealth quintile (top 20%) of the country is still the lowest, the share has gone up (while 17.2% of the total Muslim population fell in the top wealth bracket in 2005-06, it inched up to 18.8% by 2015-16). Even though in mid 1990s the community realized the importance of education, as documented by several researchers including Anwar Alam, senior fellow at the Policy Prospective Foundation, a Delhi-based think tank, it wasn’t a dramatic move. Instead some chose hybridized education, which meant that more and more Madrasas had to slowly modernize themselves to include English and computer training in their curriculum. Hence, while they were getting educated, they were enrolled in the “modern secular education system", and so this shift in mindset was reflected in the total fertility.

The share of Muslim men who have studied at least up to Class XII doubled in the decade ending in 2016, according to the NFHS. The educational status of Muslim women improved much faster than the men, though the share of women who have gotten past Class XII still remains at slightly below 15 per cent. 

A widely used measure of fertility levels is the ‘total fertility rate’, or the average number of children a woman will have in her lifetime. According to the first NFHS 1992-93), this figure was 4.3 children for Muslims and 3.3 children for Hindus, or a fertility gap of 30.3 per cent or one child per woman.   Latest NFHS-4 data shows that this gap has narrowed to 20.5 per cent in 2015-16, a difference of half a birth on average per woman, even as both communities are having fewer children than before (Table 4).

 

Table 4 Trend in number of children per women (Total Fertility Rate)

NFHS

Muslims

Hindus

Difference

1992-93 (NFHS-1)

4.30

3.30

1.00

1998-99 (NFHS-2)

3.59

2.78

0.81

2005-06 (NFHS-3)

3.09

2.65

0.44

2015-16 (NFHS-4)

2.61

2.13

0.48

Source: National Family Health Survey 1, 2, 3 and 4, IIPS, Mumbai.

Even when Muslim fertility is declining, the fertility gap would not narrow until the Hindu fertility level reached to replacement level. In demography, it is considered to be 2.1 children per woman. The former Director of IIPS and a known demographer P.N. Mari Bhat had projected that Hindus will achieve replacement fertility by 2021 and a stable population by 2061; Muslims will achieve replacement fertility by 2031 and population stabilization by 2101, and will account for 18.8 per cent of India’s population then. Bhat’s 2011 projections are extremely close to NFHS-4 figures.  So there are no chances that Muslims will overtake Hindus. 

Of course, we do not know that the rapidly declining fertility of Muslim women will continue. It would not be surprising if Muslim fertility stabilized at a higher level than non-Muslim fertility in India. As a result, Muslims may maintain a population growth rate somewhat higher than other groups and their percentage of India’s population might slowly grow. It is because the use of modern methods of contraceptive is low among Muslims as compared to others.  Religious differences in the use of modern contraception, based on the latest NFHS-4 data, clearly indicate the prevalence rate of modern contraception is the highest among Sikhs (65%) and lowest among Muslims (38%). Around 54 per cent of Hindus are protected by any modern method like sterilization, pill, IUD, condom among others (Table 4), which are available in the official programme.  The prevalence of sterilization does not differ much among most religious groups, except for the fact that it is very low among Muslims. The proportion of women and men who have been sterilized is twice as high for Hindus as for Muslims (Table 4, Column 3).

In spite of poverty and illiteracy, the prevailing unmet need for modern  family planning services is surprising, especially among Muslims.  As compared to Hindu women, Muslim women have high level of unmet need for family planning services, (12 % versus 16%), as per NFHS-4 (Table 5, Column 4).  It means that Muslim women in general do not want more children, yet they have them due to several other factors.[4] 

Table 4 India: Current use of contraception and unmet need for contraception by religion, 2015-16

Religion

% of couples (15-49 yrs) protected by  any modern method

% of couples (15-49 yrs) protected by sterilization

% of couples (15-49 yrs) having unmet need for any modern method

1

2

3

4

Hindu

54.4

38.5

12.4

Muslim

37.9

20.9

16.4

Christian

47.9

40.4

12.9

Sikh

65.4

38.9

06.4

Jain

57.6

39.4

12.1

Total

47.8

36.0

12.9

Source: National Family Health Survey-4, IIPS, Mumbai.

So, what should be the agenda? The only major religion left out of the demographic transition in India is Islam. And this group could be helped by providing family planning services, as happened in Bangladesh and Indonesia.  Muslim scholars believe that the permanent method of contraception is not permitted in Islam. So India has to diversify its approach to include other modern methods of contraception including injectables with quality in its programme like Bangladesh and Indonesia. Unfortunately, the Sachar Committee did not give importance to the concept of the reproductive health in its recommendations to improve the overall conditions of Muslims in India.[5] 

India has to find a way to talk about religious demographics as other nations do — mostly without fuss, rancor or wild policy suggestions. It is because Indian Muslims want to be part of mainstream. No doubt, Muslims have higher fertility rates than those in other religious groups.  But, in India, there is no clash of civilizations.  Indian Muslims are a part of Indian culture, as argued by the   noted Islamic Scholar Mahmood Madani. “This is because of both India’s culture and its historical legacy. Muslim heritage is a part of a larger tradition of multiculturalism and mutual tolerance. [6]

In conclusion, Islam will surely not 'overtake' Hinduism in India, but Hindutva might overtake Hinduism. Anyone with little knowledge of Basic Mathematics can calculate that if Hindus don’t produce any offspring and on the contrary if Muslims only give birth to children, then the religious demography would tip off towards a Muslim majority not before 2170.Is this practical or reasonable for commonsense? 

This kind of comic theories like Muslim Majority India are circulated and floated by vested interests with bad thoughts and intentions, I don’t understand for how long common Indians would fall for such cruel theories, people not only should refrain from such fake news, they should revert back to such people who circulate and make them understand that the root cause of all such fake news are dangerous minds.

I think that the Ministry of Health and Family Welfare (MoHFW), Government of India must address this issue squarely, and the authorities have to accept that there is a problem in the management of family planning programme and resolve it.[7]  Sound indicators are emerging that Hindu and Muslim fertility is merging 

 Matters cannot be shoved under the carpet now.



[1] For details, see: “A note on the growing demographic imbalances in the Indian subcontinent” by Dr. M.D. Srinivas, Centre for Policy Studies, Chennai, 1999. 

[3] Masoodi (2019). “Joining the India story: Rise of the Muslim middle”, mint. Read more at: https://www.livemint.com/politics/news/joining-the-india-story-rise-of-the-muslim-middle-1548262657277.html

[4] Kothari, Devendra (2015), India: Resolving Hindu-Muslim population controversies at: https://kotharionindia.blogspot.com/2015/11/

 [5] The Government of India appointed a high level committee to prepare a report on the social, economic and educational status of Indian Muslims. The 7-member committee, headed by Justice Rajinder Sachar (retired) submitted its report to the Prime Minister in November 2006. The Sachar Committee’s report is an extremely valuable document on the social, economic and educational status of Indian Muslims.

 [7] Kothari, Devendra. 2014. “Managing Unwanted Fertility in India: Way Forward,” in Sharma Suresh and Joe William (eds.):   National Rural Health Mission: An Unfinished Agenda, New Delhi: Book Well: 25-36.

 

 

Monday, 31 August 2020

India: Malnutrition and Sanitation

 

Dr. Devendra Kothari

Population and Development Analyst

Forum for Population Action

 

 

India is one of the hungriest and malnourished nations in the world.

 

 

Malnutrition is a major health problem in India.  Water, sanitation and hygiene (WASH), given their direct impact on infectious disease, especially diarrhea, are important for preventing malnutrition.

 

It is said that food grows in abundance in India, but every year, India makes headlines for being one of the hungriest major countries in the world. India ranked 102 out of 117 countries in the Global Hunger Index (GHI) 2019 that is much lower than below to its South Asian neighbours such as Sri Lanka (world rank:66), Nepal (73), Bangladesh (88), and Pakistan (94). The index is calculated using four indicators that are - child mortality, undernourishment, child wasting (weight for age) and child stunting (low height for age).

 

 

The GHI report pointed out that "India is suffering from a serious hunger problem", and the situation is deteriorating very fast, as shown in Table 1. As a result, most of its children suffer from acute malnutrition. The chapter argues that improving Wash (Water, Sanitation and Hygiene) practices could be an effective strategy in reducing the level of   malnutrition and its related issues. 

 

                    Table1 India's GHI performance since 2014

Year

World GHI Ranking

Total Countries

2014

55

76

2015

80

117

2016

97

118

2017

100

119

2018

103

119

2019

102

117

Source: GHI reports

 

Malnutrition is the primary reason behind 69 per cent of the deaths of children below the age of five in India, according to the State of the World’s Children report, released by UNICEF in 2019. The report goes on to say that every second child in India, belonging to that age group, is affected by some form of malnutrition (54% or 63 million out of 118 million children in 2018). This includes stunting with 35 per cent of the children, wasting with 17 per cent, underweight with 36 per cent and 2 per cent overweight. [1]

Chronic malnutrition, referred to as stunting, is one of the most serious health and human development problems in India. The country has the maximum number of chronic malnourished children in the world – 1 in every 3 children is stunted. The most direct causes of stunting are inadequate nutrition (insufficient food intake or consumption of foods lacking in essential growth-promoting nutrients) and recurrent infections or chronic diseases (which cause poor nutrient intake, poor absorption and utilization, or other forms of nutrient loss), as per WHO.[2]

The real-world impacts of stunting ripple well beyond linear growth. A stunted child may also have a poorer immune system, brain function, and organ development. Performing below average in these areas may also limit their future productivity and threaten the health of their future children. In short, stunting has lifelong consequences on human capital, poverty and equity. It leads to less potential in education and fewer professional opportunities,” as per Sobha Suri, Senior Fellow, Health Initiative, Observer Research Foundation. [3]

 

And, there is no wonder that the World Bank ranked India at 115th out of 157 countries on the Human Capital Index in 2018. [4] HCI seeks to measure the amount of human capital that a child born today can expect to attain by the age of 18. According to its parameters a child born in India today will only be 44 per cent as productive as she could have been if she had enjoyed quality education and full health as well as better living environment including water and sanitation.  In other words, there are grave deficiencies in India’s human development inputs that are preventing children from reaching their full potential. As such, the productivity, measured as per capita GDP,   is very low. India became the fifth largest economy in the world in terms of GDP in 2018 but still it has a very-very low per capita GDP, as per IMF. It is placed at 119th position among 185 countries.

A study by the International Food Policy Research Institute shows that stunting prevalence varies across districts of India  (12.4-65.1%), and almost 40 per cent districts have stunting levels above 40 per cent. Such high prevalence of child malnutrition in India defies logic. 

After all, the country’s economy has doubled since 1991, when the government started counting the malnourished children. Further, the world’s largest programme to tackle child malnutrition, the Integrated Child Development Services (ICDS), has been in force in the country since 1975, much before any country, other than the US, introduced measures to tackle the problem. The Mid-day Meal Scheme was launched in the year 1995 as a centrally sponsored scheme, it provides every child within the age group of six to fourteen years studying in classes I to VIII who enrolls and attends the school, shall be provided hot cooked meal having nutritional standards of 450 calories and 12 gm of protein for primary (I-V class) and 700 calories and 20 gm protein for upper primary (VI-VIII class), free of charge every day except on school holidays. The scheme covers all government and government-aided schools and also madarsas.

Now, the country aims to achieve a malnutrition-free India by 2022, as per the National Nutrition Strategy 2017.  The plan is to reduce stunting prevalence in children (0-3 years) by about three percentage points per year by 2022 from NFHS-3 (2005-06) levels, and achieve a one-third reduction in anemia in children, adolescents and women of reproductive age.

As the stage is set for the onslaught of malnutrition, it is time to critically look at the not-so-obvious reasons for its high prevalence in the country.

The debate over the measurement or prevalence of malnutrition ignores some of the crucial determinants of childhood health. Wash (Water, Sanitation and Hygiene) is a missing link. Consider this. Malnutrition is more common in India than in sub-Saharan African countries where per capita income is much lower than that of India. This discrepancy has sparked a debate over the WHO formula which is mainly based on the intake of calories, which is usually used by countries, including India, to measure malnutrition since 2006. 

Today, India lags behind sub-Saharan Africa in terms of sanitation practices. About 56 per cent people defecated, in the open across the country before the Swatch Bharat Mission (SBM) was launched in 2014. In sub-Saharan Africa, on the other hand, only 25 per cent of the people defecated in the open in 2010, according to UNICEF and WHO. Recent health surveys in the largest three sub-Saharan countries show that 31.1 per cent of households in Nigeria, 38.3 households in Ethiopia and 12.1 per cent households in the Democratic Republic of Congo defecate in the open. This difference in sanitation practices between India and African countries explains the difference in the level of malnutrition rate.[5] 

Even in India, good sanitation practices have helped curb malnutrition, as shown in Table 2. Kerala and Tamil Nadu have higher households using toilet facilities in   comparison to other states. Madhya Pradesh and Uttar Pradesh have very high rates of under-nutrition. States with low levels of under-nutrition include Kerala, Tamil Nadu and Maharashtra, although the rate is still considerably higher than that of developed nations.

                       Table 2 Uncomfortable facts: Malnutrition and use of latrine

State

Level of malnutrition (in  %)

Households where latrines in use (in %)

Kerala

20

96.5

Tamil Nadu

26

61.2

Maharashtra

28

45.1

Andhra Pradesh

32

24.9

Karnataka

33

32.1

West Bengal

35

33.7

Odessa

36

18.0

Uttar Pradesh

43

14.0

Madhya Pradesh

44

11.9

Source: National Nutrition Monitoring Bureau, Government of India.

A survey by the National Nutrition Monitoring Bureau (NNMB), which conducts surveys in rural and tribal areas to find out the nutritional status of people, also brings out this aspect. The   Bureau was established under the Indian Council of Medical Research in the year 1972, with a Central Reference Laboratory at the National Institute of Nutrition (NIN), Hyderabad. One of the surveys 

by the Bureau found that malnutrition level among children reduced over a period of time despite less intake of food. “The improvement in nutritional status could be due to non-nutritional factors, such as improved accessibility to health care facilities, sanitation and protected water supply,” the survey concluded.

Most children in rural areas and urban slums are constantly exposed to germs from their neighbors’ faces. This makes them vulnerable to the kinds of chronic intestinal diseases that prevent bodies from making good use of nutrients in food, and they become malnourished. And that explains that in spite of poverty as compared to India, Sub-Sahara Africa has lower malnourished children as compared to India.
 

That could be the reason why Narendra Modi said in a pre-election speech to mark the birthday of Mahatma Gandhi in 2013 that: India should build “toilets before temples.” To accelerate the efforts to achieve universal sanitation coverage and to put a focus on hygiene, Prime Minister Modi launched the Swachh Bharat Abhiyan (Clean India Mission) on October 2, 2014. In addition, to cleaning the streets and roads, its main objective is to reduce or eliminate open defecation through the construction of individual, cluster and community toilets by 2019, as a fitting tribute to the 150th Birth Anniversary of Mahatma Gandhi.

Since its launch on October 2, 2014, more than 86.6 million toilets have been built in India, with 513 districts and 25 states being declared open defecation free (ODF) with 98.6% of Indian households having access to toilets, according to India’s official sanitation statistics.

 

While there is no denying that millions of toilets have been built since the Clean India Mission launched in 2014, experts have skepticism about this claim.

This is in large part due to the fact that a recent WHO report estimated that in 2017, 520 million (39%) people in India were still defecating in the open. Experts wonder how, in just two short years since the report, the government of India could have created toilet access and use for all of those people? This skepticism has also been buoyed by first-hand accounts from people who continue defecating in the open because they still do not have a toilet with water supply, as per Anoop Jain, the founding director of Sanitation and Health Rights in India (SHRI), a non-profit that improves access to toilets and safe drinking water throughout rural India.[6]

Additionally, pit latrines – the government’s recommended sanitation technology in rural areas – must be emptied when full. Tankers are cost-prohibitive and often infeasible in rural areas that lack good road infrastructure. Furthermore, manual scavenging (cleaning out pits manually) has rightfully been outlawed given the myriad dangers associated with handling human feces, leaving families the only option of doing it themselves. However, the social stigma associated with handling human excrement, perpetuated by India’s caste system, deters families from doing so. This causes the pits to fill up, rendering toilets unusable, which leads people to revert to defecating in the open. As a result many of the toilets, especially in rural areas, are lying non-functional. People use these toilets for storing fodder or cow dung cakes, as noted by Jain.

In addition, India is in the midst of a water crisis. Close to half the country, about 700 million people, face high to extreme water stress. A key facet of water policy must be the induction of technology to promote reuse and store the rainwater. 

The government should take note of such issues while planning its anti-malnutrition programme.  It is suggested that the rural employment guarantee scheme (NREGA), which is the responsibility of Panchayats Raj Institutions, should be used to improve the basic amenities like water, sanitation and hygiene in rural areas. The fund allocated to the Smart Cities Mission could be used mainly to develop the basic WASH facilities in urban areas.

While toilets are an important first step for sanitation, they still need to be used. Reducing open defection requires not only the technological inputs but it requires behavioural change at the household or family level.

How to forge ahead?  Based on the available data, it is estimated that around 435 million (31%) people mainly in rural India in 2019 were still defecating in the open. Some of them even have toilets in the household premises but do not using them due to various reasons, as noted above.

 And, without focussing on this population of 90 million families, mainly comprising Dalits, other lower castes including OBCs and Muslims, India cannot think of becoming an ODF country. And, most of these are the people suffering from the incidence of malnutrition, especially stunting. We have to recognise that open defection is a problem of poverty and behavioural change. For this one has to work at the household level, as proposed in the HDPlus strategy. 

For this one has to work at the household level for behavioural change, as proposed in the HDPlus strategy.[7] 

In short, clean water, sanitation and hygiene form the backbone of an effective human development agenda, as argued by the Johns Hopkins University Water Institute. However, the challenges of providing these services in a large and heterogeneous country can be vast. Clean drinking water and sanitation are certainly not cheap. The cost of implementing these for all of India will be very large. Of course, not doing it will also have huge financial implications in terms of health and socio-economic development costs. But the big question remains – will the policymakers acquiesce?

 



 [4] Refer  2018 Human Development Index (HDI) at: https://www.onlinegk.com/news-and-tips/2018-human-development-index-(hdi)

 [5] Singh, Jyotsna and Kundan Pandey (2018).  Why India remains malnourished, DownToEarth. Read more at: https://www.downtoearth.org.in/coverage/health/why-india-remains-malnourished-42697 

[6] Jain, Anoop (2020). The end of India’s sanitation crisis? Stanford Program on Water, Health & Development. Read more at:  https://water.stanford.edu/news/end-india-s-sanitation-crisis 

[7] Kothari, Devendra (2019). Nurturing Human Development: A Strategy for New India, New Delhi: Paragoan International Publishers.