Relevance of Two-Child Norm in emerging demographic scenario of India (Part II)

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.

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[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.

Relevance of Two-Child Norm in emerging demographic scenario of India (Part I)

Dr. Devendra Kothari

Population and Development Analyst,

Forum for Population Action

The Two-Child Norm concept originates from a rich history of population control efforts and overall concern about the relationship between population growth and resource exhaustion, as advocated by Thomas Robert Malthus, British economist, in his 1798 classic writings, An Essay on the Principle of Population. He argued that how unchecked population  growth is exponential   (1→2→4→8) while the growth of the food supply was expected to be arithmetical (1→2→3→4). Many critics believe that the basis of Malthusian theory has been fundamentally discredited in the years since the publication of the Essay, often citing major advances in agricultural techniques and modern reductions in human fertility. Many modern proponents (Neo-Malthusianism), however,   believe that the basic concept of population growth eventually outstripping resources is still fundamentally valid, and "positive checks" are still likely in humanity's future if there is no action to curb population growth. The post discusses the relevance of the concept Two-Child Norm in emerging demographic scenario of India.

Shortly after independence in 1947, Jawaharlal Nehru, the then Prime Minister of India, argued in favor of “family limitation…. to promote the health and welfare of the people and development of the national economy”.[1] Nehru believed that that a smaller population would mean better living conditions for the masses. In 1952, India became the first country in the world to launch a national programme, emphasizing family planning to the extent necessary for reducing birth rates "to stabilize the population at a level consistent with the requirement of national economy”.[2] The program received 100% funding from the central government. The success of the family planning agenda was so dear to the heart of the Government of India that even a separate department coined as Department of Family Planning was carved out in the Ministry of Health in the year 1966.[3] This was done with an objective to reinforce the population control program. Further, the National Health Policy of 1983 emphasized the need for “securing the small family norm”, and stated that replacement levels of total fertility rate (TFR) that is 2.1 children per woman (or NRR 1)  should be achieved by the year 2000 to initiate  the process of population stabilization. [4]

In spite of these steps, sharp declines in death rates were, however, not accompanied by a similar drop in birth rates. India witnessed rapid fall in death rare from 25.1 in 1951 to 9.8 in 1991 and less steep decline in the birth rate from 40.8 in 1951 to 29.5 in 1991. The population of India, which was only around 361.1 million in 1951 increased by more than 2.4 times   in a period of 40 years to reach 846.4 million in 1991. The virtual stagnation in India’s population growth at high level during seventies and eighties (average annual growth rate hovering around 2.2%) was perceived by many as a failure of India’s family planning program, urgently requiring stringent measures. [5] In 1991, the National Development Council (NDC) appointed a Committee on Population under chairmanship of Sri. Karunakaran.  The Two-Child Norm (TCN) was recommended by the Committee in order to move India towards its goal of replacement level fertility by 2010. The Committee also recommended that any representative serving from the Panchayati Raj to the Parliament would lose their seat if they had more than two children while serving in office. The Karunakaran Report was endorsed by NDC in 1993, but  it was not discussed by the Indian parliament.

In 1993, the Indian Parliament passed the 73rd amendment of the Constitution that declared Panchayats as institutions of self government at the village level. In 1994, the States of Andhra Pradesh, Haryana, Orissa and Rajasthan were the first few States to introduce the TCN in Panchayats. Madhya Pradesh and Himachal introduced the norm in 2000. Maharashtra introduced it in 2003.  The provision of TCN was introduced in the Panchayati Raj Act, 1994 by inserting a specific section and amending the act by introducing a cut off date for implementation. For example, section 19(I) of the Panchayat Act of Rajasthan debars and disqualifies a person to be a member of a panchayat if he/she has more than two living children, one of whom is born on or after November 27, 1995. The number of children produced before the cut-off date is immaterial and the law is not applicable to such a case. It was realized that given the small number of elected representatives, imposing such a norm on them was most unlikely to bring a reduction in the fertility level of the State as a whole. However, the justification for this was sought in the underlying rationale that community members would perceive the elected representatives as “role models” and control their fertility.  The TCN was later introduced in the national as well as state- specific Population Policies of several states.

The four states of Andhra Pradesh (1997), Rajasthan (December 1999), Madhya Pradesh (January 2000), and Uttar Pradesh (July 2000), which recorded relatively high rates of population growth during 1971-91, drafted their population policies in the 1990s with the assistance of Futures Group International.  They set goals to lower fertility to replacement level in the shortest span of 4 to 16 years.

The announcement of the National Population Policy 2000 by the Government of India  in February 2000 and setting up of a National Population Commission, under the leadership of then Prime Minister Mr. Atal Behari Vajpayee and comprising eminent persons from all walks of life on May 11, 2000 reflected the deep commitment of the government to population stabilization program. The immediate objective of the NPP 2000 is to address the unmet needs for contraception, health care infrastructure, and health personnel and to provide integrated service delivery for basic reproductive and child health care. The medium term objective is to bring the TFR to replacement levels by 2010, through vigorous implementation of inter- sectoral operational strategies. The long-term objective is to achieve a stable population by 2045, at a level consistent with the requirements of sustainable economic growth, social development and environmental protection.

It is argued by some activists and experts that TCN as a policy prescription by government is not at all in the national interest. It distorts and subverts democracy, fundamental rights and is disempowering, particularly of women, the poor and the marginalized. Further, it exasperates and accentuates skewed child sex-ratio in general and sex ratio at birth in particular.[6] In addition, there is opposition to the provision of two-child norm in population policy in India by NGOs. [7]  Some researchers hailed the measure as  an innovative one.[8]

 To be concluded…

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[1] Connelly, M. 2006. “Population Control in India: Prologue to the Emergency Period.” Population and Development Review 32 (4) 629-667. Also see: Claire B. Cole, 2009. Responding to the Two-Child Norm: Barriers and Opportunities in the Campaign to Combat Target-Oriented Population Policies in the Post-ICPD India.  A collaborative Study by the Centre for Health and Social Justice and the Community- oriented Public Health Practice Program at the University Of Washington School Of Public Health.

[2] GoI. 2000. National Populati0n Policy 2000, MoHFW, Government of India.

[3] It was largely dictated by global pressures and the field realities in India.

[4] The National Health Policy was endorsed by the Parliament of India  in 1983 and updated in 2002. None of the health impact goals set in NHP 1983 were achieved by 2000..

[5] Visaria Leela, Akash Acharya, Francis Raj.  Two-Child Norm Victimising the Vulnerable?.  Economic and Political Weekly January 7, 2006.

[6] For detail, see: Gwatkin, D. 1975. Political Will and Family Planning: The Implications of India's Emergency Experience. Population and Development Review.  Vol.  5, (10. PP 29-59; 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; Pandey, S, (ed). 2006. Coercion Versus Empowerment. New Delhi: Human Rights Law Network.

[7]  For example, see publications of the Centre for Health and Social Justice (CHSJ), a health research and advocacy group based in New Delhi which currently serves as the Secretariat to the National Coalition Against the Two-Child Norm.

[8] Chaturvedi, Adesh, Anoop Khanna, Devendra Kothari. 2002: ‘Provision of Two-child Norm in Panchayat Raj Act of Rajasthan: A Critical Review of Impact and Perception’, Indian Journal of Social Development, Vol  2 (1), June, pp 111-23.

Empowering Women in India - Time for action

Devendra Kothari PhD

Population and Development Analyst,

 Forum for population Action

Since 1911, the March 8th is celebrated around the world as International Women's Day. Many groups around the world choose different themes each year relevant to global and local gender issues. The UN declares an International Women's Day theme for 2013 and it is “A promise is a promise: Time for action to end violence against women”.  And this is very crucial for India.

The condition of women in India has undoubtedly improved since independence. Well-dressed women in Western attire driving scooters or cars to work are now an everyday sight in cities.    Women doctors, lawyers, police officers and bureaucrats are common. However, the extent of this improvement is limited and mainly confined to the middle classes living in big cities.  As a result, the gender gap in India runs deep, as revealed by the Global Gender Gap Report 2011, released by the World Economic Forum.[1]  India ranks pathetically at 113 among the 135 countries considered, indicating India is simply not doing enough for its women. Further,   India’s ranking has been falling steadily since 2006 when the Index was launched. In 2006, India was ranked 98th. That is a shameful reflection of the condition of the women in a country that is on a growth song. Available data indicate that   the lack of education, poor health and living conditions still haunt women. It appears that India is simply not doing enough for its women to improve access to resources and freedom of movement especially for those who make around 75% of its total female population.  The situation is really worst in India's heavily populated four large north Indian States  of Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh, where, in parts, there is a deep-rooted mindset that women are inferior and must be restricted to being homemakers and child bearers. There is an urgent need to rethink as how to expedite the process of empowerment with innumerable obstacles.

The post aims at formulating a “feminist agenda” to empower women living in highly patriarchal and traditional surroundings. The agenda is based on the premises that no doubt efficient policing, stringent punishments and legal measures may “end violence against women” but they cannot eliminate growing gender inequality which is a main reason behind growing crime against women in India   unless and until the mindset of the society is changed. For this, women must have a supportive environment where she can exert herself. It is argued that the “feminist agenda" as outlined in the following pages, if implemented as a package and backed by a proper monitoring system,   will help in achieving gender equality and women empowerment in India.

What we mean by the “feminist agenda” for empowering women? The observation of the theatre personality and social activist, Shabana Azmi, appropriately sums this up: “I believe men and women are different not better, nor worse. And the difference needs to be celebrated. For far too long, solutions of all problems have sought to be resolved from male point of view. One has to take women‘s perspective into account, since women think differently”. One has to recognize that women don’t need patronage. They need supportive environment for elevating themselves and reducing the gender gap.  

Empowerment covers a large canvas where a woman is enabled to negotiate better space for herself in the family, society and polity. The ability of women to make decisions that affect the circumstances of their own lives is an essential aspect of empowerment. In other words, improving the decision making power in day-to-day activities could be another way to accelerate the process of   women empowerment. The post examines some ground level indicators, obtained from National Family Health Surveys, Census of India and other published documents, which could help in developing feminist agenda. For this, the post analyses the prevailing situation in some major States of India, namely: Andhra Pradesh, Chhattisgarh, Madhya Pradesh, Maharashtra, Rajasthan and Tamil Nadu and try to learn what one can learn. These States are at the different levels of women empowerment measured in terms of decision-making power.

During the National Family Health Survey-3 (2005-06), currently 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 to measure the level of women empowerment.[2] Using these data, the selected States have been arranged in descending order, as shown in column 2 of Table 1. Only 37% of currently married women participated in making all four of these decisions in the county as a whole. However, women’s participation in decision-making varied from 49% in Tamil Nadu to 23% in Rajasthan among the 17 major States of India having population more than 25 million in 2011. In fact, Rajasthan recoded the lowest rank in the country: only two in ten currently married women in Rajasthan participated in decisions about their own health care, large household purchases, purchases for daily need, and visits to her family and relatives, whereas every second woman in Tamil Nadu participated in all these decisions. 

Table 1 clearly indicates that the level of decision-making (col. 2) does increase with greater use of reproductive health services like Ante Natal Care (col. 3) and family planning (col. 4) that is use of reproductive health services. At the same time higher level of female literacy (col. 5) and opportunity in wage employment outside the agriculture (col. 6) have a positive impact on decision-making. Finally, higher proportion of households with toilet (col. 7) and drinking water (col. 8) facilities within the premises have expected positive association with the decision- making process.

Table 1:  level of decision making (women empowerment) depends upon use of reproductive health services, level of literacy and wage employment, and living conditions, some selected States of India.

State	%  of married women  who                                                             participate in all  four decisions*	Use of RCH services*		Literacy &  employment		Living conditions#
		% of Pregnant women received 3+ ANC visits	%  of women using modern contra-captives	% of Females  literate#	% females workers in   wage employ- ment $	% of house- holds with piped water#	% of House- Holds with latrine#
1	2	3	4	5	6	7	8
Tamil Nadu	49	96	60	74	28	80	49
Maharashtra	45	75	65	75	25	70	53
Andhra Pradesh	41	85	67	60	28	70	50
India	37	52	49	65	19	43	43
Madhya Pradesh	29	41	53	60	21	23	29
Chhattisgarh	27	54	49	61	23	21	24
Rajasthan	23	41	44	53	12	41	34
Sources: * NRHM-3 (2005-06); # Census of India 2011; $ Statistics on Women in India 2010, NIPCCD, New Delhi.

Table 1 indicates that use of reproductive health services and participation of women in wage employment in non-agricultural sector coupled with higher level of female literacy are effective action areas in empowering women. The table reveals that Madhya Pradesh, Chhattisgarh and Rajasthan recorded the very low use of reproductive health services (Cols. 3 and 4) as well as low level of female literacy and   participation in the wage employment (Cols. 5 and 6), and these had an adverse  impact on decision making power of women. On the other hand, Tamil Nadu, Maharashtra and Andhra Pradesh   with higher use of reproductive health services as well as greater   participation in wage employment recorded the higher ranking in the women empowerment (Col. 2).  As such, the State Governments have to undertaken effective initiatives to promote reproductive health services as well as the participation of women in the wage employment.  

Table 1 also indicates that other factors creating obstacles in improving the status of women are poor living conditions including   lack of drinking water and inadequate sanitation facilities, and non availability of smokeless cooking fuel like LPG and electricity. Absence of these facilities increases women’s workload as well as their physical and mental fatigue. Our earlier analysis clearly indicates the living conditions are equally important in empowering the women.[3]

All these ground level variables have a significant impact not only on the decision-making power of women (Col. 2) but also on the quality of life of women measured in terms maternal mortality rate (Col. 3), number of unwanted births per women (col. 4), per cent of births of order four or higher (Col. 5), proportion of employed women who are paid in cash for their work (Col. 5), and percentage of women who have a bank account that they themselves use (Col. 6), as shown in Table 2. The table indicates that maternal mortality rate varies from 318 maternal deaths per 100,000 live births in Rajasthan to only 94 in Tamil Nadu. Similarly, level of unwanted fertility that is difference between the total fertility and wanted fertility ranges from 0.3 children in Andhra Pradesh to 1.0 child in Madhya Pradesh and Rajasthan.[4] The consequences of unintended pregnancy are serious, imposing significant burden on women and families, and in turn slowing down the process of women’s empowerment. Unintended pregnancy breeds powerlessness and powerlessness breeds subordination (quality of obedient submissiveness) and subordination breeds unintended pregnancy[5].  

Table 2:  level of decision making (women empowerment) and quality of life indicators, some selected major States of India

State	%  of women  who                                                             participated in all  four decisions*	Maternal deaths/lac live births 2007-09 (MMR)#	Number of unwanted births/ woman*	% of  birth order four or higher*	% of employed women earning cash*	% of women who had bank account that they use*
1	2	3	4	5	6	7
Tamil Nadu	49	97	0.4	7	90	16
Maharashtra	45	104	0.4	12	70	20
Andhra Pradesh	41	134	0.3	8	84	18
India	37	212	0.8	25	64	15
Madhya Pradesh	29	269	1.0	31	59	9
Chhattisgarh	27	269	0.6	28	45	8
Rajasthan	23	318	1.0	34	48	8
Sources: * NRHM-3 (2005-06) and # Registrar General of India.

In conclusion, there are quite a large number of issues which need to be addressed to streamline the existing women empowerment programs in India especially in the poor performing States as well as initiate actual work at the ground level. To initiate the measurable actions at the ground level, female education and women centred reproductive health services should be given top priority. Other factors need attention are making access to affordable LPG cooking fuel for rural women, providing safe drinking water, and sanitation and enhancing the opportunity for wage employment. We have to accept the fact that things are not going to change overnight but because of this we cannot stop taking action either. At this junction the most important step is to initiate ground level actions however small it might seem. They should be focused on creating enabling environment where women can take decision about themselves, and that will be a starting point in our efforts to empower women in India.

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[1] The Global Gender Gap Index, introduced by the World Economic Forum in 2006, is a framework for capturing the magnitude and scope of gender-based disparities and tracking their progress. The Index benchmarks national gender gaps on economic, political, education- and health based criteria, and provide country rankings that allow for effective comparisons across   regions and income groups, and over time. For details, see: The Global Gender Gap Report 2011, World Economic Forum, Geneva, Switzerland, 2011.

[2] For further information, see: Sunita Kishor and Kamla Gupta. 2009. Gender Equality and Women’s Empowerment in India. National Family Health Survey (NFHS-3), India, 2005-06. Mumbai: International Institute for Population Sciences; Calverton, Maryland, USA: ICF Macro. 

[3] See post on: “Quality of life and living environment in India” dated September 30, 2012 by the author at the link: kotharionindia@blogspot.com. Also see  article  by the author “West Bengal: Household amenities with special reference to water, sanitation and hygiene (WASH) and their implications”, UNICEF West Bengal, Kolkata, 2012

[4] The highest unwanted fertility of 1.6 children per woman was recorded by Bihar in the country as a whole, as per NFHS-3.

[5] Kothari, Devendra. 2012. “Empowering Women in India through better Reproductive Healthcare”, in Sheel Sharma and Angella Atwaru Ateri (eds.) Empowering Women through Better HealthCare and Nutrition in Developing Countries, New Delhi: Regency Publications, 2012, pp 68-86.