Dr. Devendra Kothari
Population and Development Analyst,
Forum for Population Action
The concept Two-Child Norm (TCN) as a policy measure was
introduced in some States of India through the Panchayat Raj Institutions as
well as population policies in the late nineties, as noted earlier (see part I).
The governments of these States
insist that those with more than two living children are debarred from
contesting panchayat elections or remaining in office. Now question arises whether this intervention has been able to achieve its intended impact
on the population growth.
Over the past 20 years there has been a
steady decline in the annual population growth rate from 2.14% in 1991 to 1.95
in 2001 and further to 1.62% in 2011. The rate of growth has declined in all
the States and Union Territories (28 States and 7 UTs) during 2001-2011 except
Tamil Nadu, Chhattisgarh and tiny Pondicherry (UT), and this is a good sign.
The rate of decline was slow in the Four Large North Indian States of Bihar,
Madhya Pradesh, Rajasthan and Uttar Pradesh as compared to other States of
India. Though the annual growth rate
during 2001-2011 has registered the sharpest decline since independence, in
absolute terms the population of India has increased by a whopping 181.5
million during the period. The absolute addition during the decade was slightly
less than the previous decade (182.3 million). Demographic projections show
that India is likely to cross China as the most populous nation before 2025.[1]
India's Total Fertility Rate
(TFR) - the average number of children that would be born to a woman over her
lifetime - that has remained stagnant at 2.6 since 2009 could finally see a drop
in 2011, as per the Registrar General of India. However, India has seen a
steady decline in TFR during the last two decades that has come down by 31%
from 3.6 in 1991 to 2.5 in 2011. Among major States of India having
population 25 million or more in 2011, Bihar (3.6 children per woman), Uttar
Pradesh (3.4), Madhya Pradesh (3.1), Rajasthan (3.0), Jharkhand (2.9) and
Chhattisgarh (2.7) have worst TFR; while Tamil Nadu (1.7), West Bengal (1.7),
Andhra Pradesh (1.8), Kerala (1.8), Maharashtra (1.8), Punjab (1.8), and Karnataka (1.9) have already achieved targeted replacement level fertility required to
initiate the process of population
stabilization. According to the National
Population Policy 2000, India should have reached replacement-level fertility
rate of 2.1 by 2010, and attain population stabilization at 1450 million by
2045. The stable population is a stage when the size of the population remains
unchanged. It is also called the stage of zero population growth. However,
India expects to reach population stabilization of 2.1 TFR at 165 crore by
2060.
As noted earlier, Andhra Pradesh, Rajasthan,
Madhya Pradesh and Uttar Pradesh adopted State-specific Population Policies
with a provision of TCN in late nineties but except Andhra Pradesh remaining
States could not achieve the targeted
fertility goals, as shown in Table 1
(Cols. 2 and 3). For example, Madhya Pradesh aimed at achieving the
replacement level fertility of 2.1 children per woman by 2011 but it is far
away from the targeted goal – it recoded TFR of 3.1 in 2011. On the other hand,
Andhra Pradesh was able to achieve the goal of
replacement fertility, as targeted.
It appears that incentives, disincentive or legal
restriction on couples over the number of babies they can have (like TNC) are not going help to
achieve the goal of population stabilization. What we need is the client
centred service delivery system.
Table 1: Targeted
Total fertility (TFR) to be achieved by 2011 as per population Policies and
actual TFR in and level of unwanted fertility and unmet need for modern
contraceptives.
|
States with Population Policy (with year of adoption )
|
Targeted TFR to be achieved by 2011 as per Population
Policy*
|
Actual TFR in 2011**
|
No. of unwanted children/ woman@
|
% of total births 4+@
|
% of unmet need for contraceptives@
|
|
1
|
2
|
3
|
4
|
5
|
6
|
|
Andhra Pradesh (1997)
|
1.5
|
1.8
|
0.3
|
08
|
05
|
|
Rajasthan (1999)
|
2.6
|
3.0
|
1.0
|
32
|
15
|
|
Madhya Pradesh (2000)
|
2.1
|
3.1
|
1.0
|
31
|
11
|
|
Uttar Pradesh (2000)
|
2.6
|
3.4
|
1.5
|
38
|
21
|
|
Bihar#
|
--
|
3.6
|
1.6
|
36
|
23
|
|
India (2000)
|
2.1 (2010)
|
2.4
|
0.8
|
25
|
13
|
|
Note” # Bihar does not have a state-
specific population policy.
Source: * Population policies,
**Registrar General , India :
@National Family Health Suvey-3
|
|||||
Andhra Pradesh is one such example. During
the early nineties, the State government decided to revamp its reproductive
healthcare delivery system looking to the needs of clients[2].
It was a political decision and this increased the use of reproductive health
services significantly.[3] As
per the NFHS-3,[4]
more than two-thirds
of married women in Andhra Pradesh used modern contraception in 2005-06, one of
the highest in India. It had dramatic impact on fertility by reducing
unwanted pregnancies. Andhra Pradesh
exhibits one of the lowest fertility among major States of India – 1.8 children
per woman. It is interesting to note that women with no education or
less than 5 years of education are more likely to use contraception than women
with more education, since reproductive health services are easily available
looking to the needs of clients. As a
result, only 5% of currently married women have an unmet need for family
planning, down from 8% in NFHS-2 (1998-99) and 10% in NFHS-1 (1992-93).
Currently, 94% of the demand for family planning is being satisfied, up from
82% in NFHS-1. The impact of client centered reproductive health care could be
seen from a comparison of the birth order distribution in NFHS-1, NFHS-2, and
NFHS-3 for married women. The proportions of births of order four or higher
decreased from 22% in NFHS-1 to 15% in NFHS-2 and 8%t in NFHS-3. All these had an
impact on the level of unwanted fertility.
Andhra Pradesh recorded one of the lowest unwanted children per woman in
India (0.30, as shown in Table 2 (Col.4).
Not only in family
planning but in other areas of reproductive healthcare, Andhra Pradesh has done
equally well. In
the State, 85% of women had at least three antenatal care visits for their last
birth.
On the other hand, total fertility in
Rajasthan is the third highest among the major states of India. The largest differentials in
fertility are by economic status and education. At current fertility rates,
women with no education will have twice as many children as women with 10 or
more years of schooling (3.7 children per woman compared with 1.8). Among the
major States of India, total unwanted fertility is the third highest in
Rajasthan (one child per woman), as shown in Table 1. Despite a 15 percentage point increase in
current contraceptive use among currently married women since NFHS-1, less than
45% of women in Rajasthan are currently using any modern contraceptive method. Around
15% of married women in Rajasthan have an unmet need for family planning (Col.
6), down from 18% in NFHS-2. The distribution
of births by order is yet another way to view fertility and performance of
reproductive healthcare service delivery system. Around one third of total
births in Rajasthan in 2005-06 were of order four or higher, which was the
third highest among the major States of India. Further, no significant decline
was seen in the higher order births between NFHS-2 and NFHS-3: 34% versus
32%. Despite substantial improvement in the
coverage of antenatal care for mothers, only 4 in 10 women in Rajasthan
received at least three antenatal care visits for their last birth in the past
five years. Full immunization coverage is lower in Rajasthan than in any other
state except Uttar Pradesh, as per NFHS-3. A little more than
one-quarter of children age 12-23 months are fully vaccinated against six major
childhood illnesses: tuberculosis, diphtheria, pertussis, tetanus, polio, and
measles.
It
appears that poor performing States,
containing around 50% of total population of India, are not able to
provide clients centred reproductive health services. More than 15
million currently married women in 2011, mostly in these Srares have an unmet need for family planning,[5]
and that figure is increasing. 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/unplanned pregnancies. More than 26
million children are born every year in India; and out of this about 6 million
births have been classified as unplanned/unintended or simply unwanted. Based
on findings of the National Family Health Surveys 1, 2 and 3, it is estimated
that currently there are around 450 million people out of 1200 million in India
who are product of unwanted pregnancies, and most of them are from the lower
economic strata.[6]
In
sum, over the past three to four decades, many State governments in India have
experimented with schemes like TNC including specific incentives and
disincentives to lower the rate of fertility. Most such schemes have had only
marginal impact and, in some cases, have been counterproductive. Thus, first priority is to provide universal access to
family planning, as set out in Millennium
Development Goal 5b
– achieving universal access to reproductive
health by 2015. Without this, women
are unable to exercise their reproductive rights. The principle of informed choice backed by
quality RH services is essential to the long-term success of the family
planning programs. Any form of coercion has no part to play. Though very-very
small numbers of elected representatives of local-self government including
Panchayats have so far been removed under the Two-Child Norm policy,[7]
but there
is no need to implement such measures or to provide incentives and
disincentives to achieve the goal of stable population. I, therefore, strongly urge for removal of the Two-Child
Norm in our efforts to achieve population stabilization. In the changed situation most of the couples, even those
belonging to the lowest economic strata, do not want more children. But, they
still have them, primarily due to lack of client centered reproductive
healthcare. The real need is to provide
services in un-served and underserved areas by realigning the capacity of
health system to deliver quality care to suit the needs of clients, especially
those belonging to the “bottom of pyramid”. Therefore, reproductive healthcare
should be an essential plank in achieving population stabilization and
empowering the poor. At
the same time, investment in education has to be increased to improve the
quality of education especially at the government schools and colleges where
most of the students are from poor and rural families. It is because the pivot
upon which the fate of the nation hangs in balance is education.
[1]
Kothari, Devendra. 2011. Implications of Emerging
Demographic Scenario: Based on the Provisional Results of Census of India 2011,
A Brief, a publication of Management Institute of Population and Development.
Parivar Seva Sanstha, New Delhi.
[2] Among many
initiatives of the Government of Andhra Pradesh, the establishment of “Round
the Clock Women Health Centres” wan an
important one. 470 PHCs (Primary Health
Centres) in the backward areas have been designed as Round the Clock Women
Health Centres in the nineties. Normal delivery services are being provided
round the clock in these centres by nursing staff of PHC. 450 doctors as well
as ANMs have been taken on contract in these PHCs. Specialist clinics by
Gynecologist and Pediatrician are being provided in these institutions on a
fixed day once in a week. Additional facilities like telephone and vehicle for
transportation are also provided to improve communication and referral system
for emergency cases. For detail, see
document: Brief of the Family Welfare
Department, Office of Commissioner of Family Welfare, Government of Andhra
Pradesh, Hyderabad, 20.06.2003.
[3] Kothari Devendra
and Sudha Tewari. 2009. Slowing Population i Growth in India: Challenges,
Opportunities and the Way Forward. MIPD Policy Brief No. 2, Management
Institute of Population and Development. New Delhi.
[4] IIPS.
2007. India: National Family
Health Survey, 2005-06. Mumbai:
International Institute for Population Sciences.
[5] The standard
definition of unmet need depends upon the apparent inconsistency between a
woman’s contraceptive behavior and her stated reproductive preferences. The
concept of unmet need was highlighted first time in India in a study conducted
by the author in Rajasthan in 1988-89 on behalf of Ministry of Health and
Family Welfare, Government of India. For details, see Devendra Kothari, “Family Planning Programme in Rajasthan:
Beyond the Existing Approach”, Indian Institute of Health Management
Research, Jaipur, 1989.
[6] Ibid. Kothari Devendra. 2011.
[7] According to Nirmala Buch, who runs a
Bhopal-based NGO, 412 panchayat members
in Rajasthan, 350 in Madhya Praddssh and
275 in Haryana have already been
removed from their posts, because they failed to comply with the two-child
norm. Refer: Buch,
Nirmala. 2005. Law of Two-child Norm in
Panchayats: Implications, Consequences and Experiences, Economic and Political
Weekly, Vol 40, (24), June 11, pp 2421-29.
