"Skill, Scale and Speed” and growing unwanted fertility

Devendra Kothari PhD

Population and Development Analyst

Forum for Population Action

Population stabilization should be a priority for development in India, and then only it will be able to sustain growth.

India is a great success story of economic growth and poverty decline, but it remains the home of global poverty as well as illiteracy, and half of its children are profoundly malnourished. Further, a recent report of the World Bank reports that India’s income inequality doubled in the two decades to 2011. This paradox of poverty and plenty poses one of the great intellectual and moral challenges of the day.  However, under the new political leadership India has the opportunity to show the rest of the develop­ing world how open, democratic societies can achieve rapid as well as environmentally sustainable growth and shared prosperity; but this requires more painstaking effort towards focusing on real interventions. And that may be the reason while speaking at a function to release a book, [1]  Prime Minister Narendra Modi said that the nation needs to think big and focus on “skill, scale and speed” to revive India's growth story and called for substantially enhancing the "input of intellectual think-tanks" for better policy frameworks. The PM later tweeted "Sadly, role of think tanks has not increased to provide critical inputs to policy making;" and this post aims in this direction and suggests critical  policy inputs to spur India's growth trajectory.

Population and development are interrelated:

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 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 5-7 years. India's population is projected to peak at 1.7 billion in 2060. China at its peak in 2025 will have 1.4 billion people. In fact, when China peaks, India will have already surpassed it in population. Many Indians including policy makers see these emerging demographics as a critical advantage in competition with the nation it regards   as its chief rival – China.  Another popularly held belief by India’s policy makers and experts 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 economic reforms in 1991, India has become one of the fasted growing major economies in the world. The economic reforms completed 20 years in July, 2011, however, during this period, India’s population increased by 365 million, much more than the total population of USA - the third most populous country in the world; and it is still growing by around 17 to 18 million every year.  This raises the question: Is Development the Best Contraceptive or Are Contraceptives? 

Magnitude of unwanted fertility:

Current population growth is mainly fuelled by unwanted fertility. More than four in ten pregnancies are unintended/unplanned or simply unwanted by the women who experience them and half or more of these pregnancies result in births that spur continued population growth.  Around 26 million children are born in India every year and out of this about 6 million births have been classified as unplanned/unintended. Based on findings of the National Family Health Surveys 1, 2 and 3, it is estimated that currently there are around 460 million people out of 1270 million in India who are product of unwanted pregnancies, and most of them are from the lower economic strata. [2]  The consequences of unwanted pregnancy 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 unwanted childbearing is reflected in widespread hunger, poverty, unemployment as well as increasing scarcity of basic resources like food, water and space in several parts of India despite concerted developmental efforts since 1991.

In short, population growth fueled by unwanted fertility is not only distressing but it is also demoralizing. Broadly speaking, the galloping population growth in India has created obstacles in the way of economic development. In the following pages four important implications of galloping population are discussed which hampers “speed” of economic progress.

I-Demographic dividend or disaster:

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. So, it is fashionable now to talk of India’s “demographic dividend”. By 2030, India will be the youngest big nation in the world, with an average age of 29 years. Can India take advantage of this demographic window in the next couple of decades?   Emerging situation is candidly summarized by a leading journalist - Shekhar Gupta:  “Unless our totally moribund system of education is revolutionized, this dividend will become a curse. India would then end up having the largest population of angry, unemployable young lumpens   in the history of mankind. Even India will not have the resilience to survive the calamity”. [3]  A radical revamps of education from top to bottom is the only way to do justice to the politics of aspiration .[4]

II-Increasing gender gap:

Gender equality is an essential ingredient for India’s development. However, India still has quite long way to go in bridging the gender gap in the areas of health, education and economics, if not politics. It has been ranked 101 among 136 countries in The Global Gender Gap Report 2013 released by the World Economic Forum. Also, the country has fallen from 96^th rank in 2006 to 101 in the last 8 years, revealing a stark and deep rooted gender gap in India. 

India is simply not doing enough for its women to improve access to resources and freedom of movement as well as improving decision making power. Poor availability of reproductive health, education and other facilities creates obstacles in improving the decision making power of women.  During the National Family Health Survey-3, the married women were asked who made decisions about their own health care, major household purchases, purchases for daily household needs, and visiting their own family or relatives etc., in order to be able to measure the level of women empowerment. Only 37% of the total currently married women along or jointly with their husband participated in making all four of these decisions in the county as a whole. However, among the 17 major states of India having population more than 25 million in 2011, women’s participation in decision-making varied from 49 per cent in Tamil Nadu to 23 per cent in Rajasthan.

There is an urgent need to rethink as how to expedite the process of women empowerment or their decision-making power  in a patriarchal and traditional society with innumerable obstacles, since empowered women have a significant role in  India's growth trajectory.  To deal with a problem that has roots in social behavior and prejudice, mere legislation is not enough. One has to create an environment where sons and daughters are equally valued.  For this, women must have access to education and training along with economic empowerment through property rights, favorable credit and entrepreneurial support as well as opportunity in paid employment.  At the same time, insuring reproductive rights could be another but effective way to promote favorable conditions to empower women in India. In a patriarchal society, where power relations make women passive and subordinate, reproductive technology can help them to break this vicious circle. In other worlds, the reproductive healthcare is an important pre-requisite to create an environment where women can take decisions regarding the number, timing and spacing of their children. Therefore, addressing inequalities in access to and use of reproductive health services including contraceptive services could be a powerful tool in empowering women in India. [5]

III-Emerging demographic divide – a challenge for development:

Over the last two decades, which are coterminous with the era of economic reforms, Indian economic growth has accelerated, making it the third-fastest growing economy in the world. But it has had highly regressive impact since inter-state disparities, for instance, has tended to widen even more than before. This divide is more pronounced when we compare the FLNI States or so called BIMARU States of Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh with Four Southern Indian (FSI) States of Andhra Pradesh, Karnataka, Kerala and Tamil Nadu.  In the post-reform period the gap between FLNI and FSI States has increased on many socio-economic indicators.  What is holding back the growth story of FLNI States?  These States are growing slowing not because of poverty or low level of education but mainly due to their galloping population growth fueled mainly by unwanted or unintended fertility (Table 1).

Table 1: Emerging north-south demographic divide, 2011

States	Total population 2011 (million)	% Annual population growth 2001-2011	Number of children/ woman 2005-06	Number of  unwanted  children/woman 2005-06
1	2	3	4	5
Bihar	103.8	2.26	4.0	1.6
Madhya Pradesh	72.60	1.86	3.1	1.0
Rajasthan	68.6	1.96	3.2	1.0
Uttar Pradesh	199.6	1.86	3.8	1.5
India	1210.2	1.62	2.7	0.8
Andhra Pradesh	84.7	1.06	1.8	0.3
Karnataka	61.1	1.49	2.1	0.5
Kerala	33.4	0.48	1.8	0.1
Tamil Nadu	72.1	1.46	1.8	0.4
Source: Census of India 2011 and National Family Health Survey-3, 2005-06.

Census of India 2011 reveals a sharp decrease in the rate of population growth in FLNI States as compared to FLNI States during the last two decades of economic reforms. In 1991, the FSI States had 23 per cent of India’s population and by 2011, that figure has declined to 21 per cent. In 2051, the combined population of these States is projected to be only 16 per cent of the country’s total. On the other hand, the population of the FLNI States increased from 34% in 1991 to 37% in 2011 and it will be around 45% in 2051. It means all the future population growth will be accounted by the poor performing states.  While all the FSI States have already reached below the replacement level fertility of 2.1 children per woman required to initiate the process of population stabilization, the FLNI States have a long way to go before they achieve this level. On an average a woman in India produces 2.7 children during her lifetime; however, there is a wide diversity of fertility levels among these States. It ranges from 1.7 in Andhra Pradesh to 4.0 in Bihar, as per the NFHS-3.  The difference between the actual fertility and the total wanted fertility that is unwanted fertility, ranges from 0.3 children per woman in Andhra Pradesh to 1.6 children in Bihar. Aside from Bihar, the difference of one child or more was observed in Uttar Pradesh (1.5), Madhya Pradesh and Rajasthan (1.0 each), as shown Table 1(Col. 5).

The emerging demographic peculiarity could have major ramifications as India attempts to continue its high economic growth rate over the coming decades. Armed with reams of demographic and other relevant data, Nicholas Eberstadt, a senior political economist and demographer at the American Enterprise Institute, a Washington, DC think-tank, argued that India is bisected by a great north-south fertility divide, in much of the north, fertility levels remain quite high, at four, five, or more children per woman; in much of the south India, however, fertility levels are at, or already below, the replacement level.[6] This is a challenge for India's development in the decades immediately ahead. Further, experts say the demographic imbalances could also fan political tensions. It is in this context that fear policies playing havoc with human numbers in the country is not largely unfounded. [7]   IV - Hindu-Muslim demographic imbalances  – a serious concern: Another demographic characteristic which may have major ramifications for development as well as population stabilization effort is the pattern of   Hindu-Muslim population growth. There is a widespread feeling that the main cause of population explosion in India is due to the   higher fertility among Muslims as compared to other religious groups, especially Hindus.  Even some argued that the growing demographic imbalances in India should indeed be matter of serious concern as they seem to have serious repercussions on the very survival of the “Indian civilization”[8]. The Indian Muslims are not in a majority, but they are also not a negligible minority. India has the third highest concentration of Muslims worldwide after Indonesia and Pakistan. The Muslim population was 138 million out of a total population of 1028 million in 2001. Percentage wise, Muslims were about 13.4% of the total population, as compared to 80.5% Hindus (including Scheduled Castes and Tribes) and 6.1% other minorities (Sikhs, Christians, Buddhists, Jains, etc.). Currently, the Muslim population is around 170 million, as per the estimated figure for the year 2011.  The annual growth rate among Muslims has averaged 2.7% between 1961-2001, which is well above the national average population growth of 2.1% and the Hindu growth rate of slightly less than 2%. No doubt, Muslims have higher fertility rates than other religious groups. Number of children/ woman is almost half a child higher for Muslims than for Hindus in 2005-06, as shown in Table 2. However, the Hindu-Muslim fertility differential declined significantly from 1.1 children per woman in 1992-93 to less than 0.5 in 2005-06.  Muslims recorded the highest decline in fertility among major religious groups in India.  This is a remarkable development and indicates that India’s Muslims are now moving closer to joining the Indian mainstream buttressed presumably by the reality that in the end-game the Indian Republic has made strides and protected the rights of India’s Muslims. Table 2: Trends in number of children per woman by religion Religion Number of children per woman (Total Fertility Rate) 1992-93 1998-99 2005-06 % decline 1993-06 Hindu 3.30 2.78 2.65 -20 Muslim 4.41 3.59 3.09 -30 Christian 2.87 2.44 2.35 -18 Jain 2.77 2.33 2.02 -27 Sikh 2.43 2.26 1.97 -20 Total 3.39 3.85 2.68 -21 Source: National Family Health Surveys 1,2 and 3 Is India going Muslim? Projections for future population growth in India show that by the end of the 21st century India’s total population will stabilize in which the Muslim population would be less than 20% of total, as noted by the  Sachar Committee[9]. Thus the propaganda that the unchecked growth in the Muslim population will result in their overtaking the Hindu population is totally false. Further, if the rates of decline of fertility we saw from 1992 to 2005 continued for another 15 years then in the year 2020 the total fertility rate of Muslims and the Hindus would be about the same. As the Muslim population is much younger it would continue to grow more rapidly than the non-Muslim for some time, but eventually the growth rate of both populations would be the same and the Muslim portion of the India’s population would tend to stabilize. Well, the only major religion left out of the demographic transition in India is Islam. Unmet need for family planning is particularly high for Muslim eligible couples. And they could be helped by providing family planning services looking to the needs of clients as happened in Bangladesh. The second issue - that is very important - is that the Indian family planning program has predominately promoted female sterilization. Many 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 program. New political leadership in Delhi is keen to bring them into the mainstream. While responding to the President's Address in the joint session of the Parliament on June 11, 2014, Prime Minister Narendra Modi made a point about the Muslim community: “We need to bring them into the mainstream. We can't leave them behind.” Making a point on inclusive development, he said, “If a limb is disabled, the whole body is disabled.” PM Modi knows that without Muslims’ cooperation it will be difficult to push India’s growth story. Here quality reproductive health and education services could help them to join main stream. Discussion:  To make “Skill, Scale and Speed” a workable framework, there is an important lesson India must learn from modern history. When emerging economies thought about inclusive and sustainable development some forty years ago, they gave importance to some basic issues like population stabilization and quality education in their development package.  Table 3 (Col. 2) indicates that fertility levels were quite high, at five, six, or more children per woman of these economies in 1970.  After forty years most of these economies have achieved or going to achieve stabilization in their population growth, but India has a long way to achieve this. Today, a woman in India produces 2.6 children during her lifetime. The replacement level fertility of 2.1 children per woman, required to initiate the process of population stabilization, has already been achieved by Thailand (1.5), China (1.6), Brazil (1.7) and even Islamic country Iran (1.9), as shown in the table (Col. 3).  Indonesia, another Muslim dominating country, is going to attain it within couple of years; however, India will achieve this level not before 2035, as per the UN Population Division. As a result, ‘Demographic Transition’ in India has stalled midway and is adversely impacting  parameters like poverty, education, employment, nutrition, gender equality, health and especially  governance.  On the other hand, remaining emerging economies, as shown in Table 3, have improved the quality of life parameters in terms of health, education and wellbeing ( Cols.  5, 6 and 7). India has reached a crisis point with respect to the interlocking issues of unwanted fertility, unsustainable development and human suffering. As such, India must take a position that every child should be a wanted one. Achieving this goal would prevent the suffering of women and their families and the socio-economic problems that often follow the birth of unwanted children. Incidence of unwanted pregnancies can be dramatically reduced, if not eliminated, within a decade by revamping family planning programme looking to the needs of clients,   as has been done in Andhra Pradesh, one of the states of India.  If Andhra - with little outside help - can manage its population issue under relatively low level of literacy, there is no reason why Four Large North Indian States of Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh 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. Table 3: Trends in total fertility and levels of infant mortality, life expectancy at birth  literacy and poverty, selected countries Country Number of children per woman (TFR)* Infant deaths/ 1000 births (IMR) Life expectancy at birth (in years) % literates (age 15 and over  who can read and write) % of population under international poverty line 1970 2010 2010 2010 2012 2009-11 1 2 3 4 5 6 7 India 5.7 2.6 51 65 61 32.7 Brazil 5.4 1.7 24 72 89 6.4 china 6.0 1.6 18 74 92 13.1 Indonesia 5.6 2.2 29 71 90 18.1 Iran 6.7 1.9 21 73 77 1.4 Mexico 6.8 2.3 17 76 86 3.0 Thailand 6.0 1.5 12 74 93 5.0 Source: *World Population Prospects: The 2012 Revision and **CIA World Fact book. The need of the hour, therefore, is to create confidence among policy makers and programme managers that a breakthrough is possible. There is no need to implement coercive measures or to provide incentives and disincentives to stabilize the population. The real need is to provide reproductive services in un-served and underserved areas by realigning the capacity of health system to deliver quality care to suit the needs of clients. We need creative policies to strengthen this foundation, as shown by Andhra Pradesh. Demography, therefore, in the next 10 years or so will pose serious challenges to economic growth, democracy and national unity by its sheer size. Unless the Centre and FLNI states engineer a common population stabilization program to lift these economies, the shadow of poverty and illiteracy as well as poor governance issue will continue to haunt India and thwart its tryst with destiny. This is a challenge for India’s development in the decades immediately ahead. To make India relevant again, Modi has no time to lose.

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[1] Released book edited by Bibek Debroy, Ashley Tellis and Reece Trevor titled "Getting India Back on track - an action agenda for reform", Carnegie Endowment for International Peace, 2014.

[2] Kothari, Devendra. 2014. “Managing Unwanted Fertility in India: Way Forward”, Institute of Economic Growth (ed.):   National Rural Health Mission: An Unfinished Agenda, New Delhi: Book Well. 

[3] Gupta, Shekhar. 2014. Anticipating India: The Best of National Interest. New Delhi: Harper Collins.

[4] Kothari, Devendra. 2014. Education in India needs intensive care, not a quick fix, RAEA Policy Paper No. 1. Rajasthan Adult Education Association, Jaipur.

[5] Kothari, Devendra. 2014. “Empowering women in India: Need for a Feminist Agenda”, Journal of Health Management, 16 (2), pp 233-43.

[6] Refer article “Two Different Indias are Being Born” at: http://www.rediff.com/getahead/report/india-demographic-dividend-education-youth/20110318.htm. Also see post by the author: “Emerging Demographic Divide: A Dilemma for India” at http://kotharionindia.blogspot.in/2012/02/emerging-demographic-divide-dilemma-for.html .

[7] Kothari, Devendra. 1999. “Likelihood if two ‘Nations’ emerging: A dilemma for India”, IIHMR UPDATE, Volume 2 (1), Indian Institute of Health Management Research, Jaipur.

[8] 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.

[9] In March 2005, 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.