Population of India: What the Government Should Do

The family planning initiatives in India are usually stuck on only one thing – female sterilization. The policy makers sitting in New Delhi or in State capitals set targets of number of sterilizations and the bureaucrats galvanize the state machinery to set up sterilization camps to achieve the goals. All may be well on papers but ground reality of both implementation and the ossified thinking that “population control only means female sterilization” betrays the changed demographic realities of India.

Ground level health workers know “how these numbers are gathered” and goals achieved. Bureaucrats are, of course, unconcerned as long as they are given reports of targets achieved. They also don’t bother to stop and think “Why female sterilization and sterilization camps should be the only solutions to check population growth?”

Let us examine what the demographic indicators are saying loudly and why the over-hyped female sterilization is not the correct solution to manage Indian population. And also why the population stabilization battle should be fought on the societal and developmental territories too.

A. Young India

India is at an important stage of demographic transition. Look at the following figures:

Almost 40% of Indians are younger than 15 years of age,

Over 50% of its population below the age of 25, and

Over 65% hover below the age of 35.

It is expected that, in 2020, the average age of an Indian will be 29 years, compared to 37 for China and 48 for Japan. By 2030, India's dependency ratio should be just over 0.4. Dependency ratio is nothing but total number of people who normally don’t work (below 15 and above 64) divided by those in the productive work force (age group of 15 – 64).

It is a young India now; its needs can not be met merely by offering permanent pregnancy termination method as a form of contraceptive.

B. Why is the population still Increasing when the average family size is Decreasing?

In 1950s, the average number of children a woman had in her life time (called Total Fertility Rate (TFR)) was over six; now it is less than half of that and for most Indian States it is less than 2. Yet, the population continues to grow.

India continues to add about 18 million people per year because over 50% population is in the reproductive age group. It is this large base of young reproductive people that imparts momentum to the growth of population. Also, the number of people entering the reproductive age group increases by the year due to the high birth rate of the previous years. So, the population growth is momentum driven.

The importance of momentum driven population growth has increased as fertility levels throughout the world have declined. In 1994, John Bongaarts estimated that population growth due to momentum could account for nearly half of world population increase during the twenty-first century. He pointed out that this momentum driven population growth could be reduced simply by raising the average age of childbearing. He further estimated that a 2.5 year increase in age at first birth would reduce population growth momentum by 21%.

Therefore, the correct ways to check population momentum are by delaying marriage, child bearing, and by spacing births.

C.  Where is the Real Problem?

Five states with 44% of India's population will contribute 55% of population growth up to 2016.Performance of these states will be the decisive factor in the efforts of population stabilization. Family planning initiatives in these states need particular attention in order to bring down the national average TFR.

Making only females responsible for family size is nothing but a gender bias in India and males should be also made equally responsible for fertility and child care related activities. Gender bias apart, there are other compelling reasons why focus on permanent sterilization method is a wrong prescription to check population growth.

1. When sterilization is the only available method to prevent pregnancy, it leads to several distortions. For example, people tend to go for quick pregnancies before sterilization. This actually adds to population momentum which is the prime cause of population growth.

2. Experts advice against female sterilization below the age of 27 because it leads to higher complication and failure rates. NFHS – 3 data clearly indicate that most of the sterilization are done at younger age – sometimes as young as 20 year or even younger. Moreover, female sterilization also increases the risks of hysterectomy by four times. Therefore, heavy dependence on sterilization is not only putting young women to future health risks, but also depriving them of other contraceptive choices – better suited to their needs.

3. Encouraging sterilization camps is bad for two reasons: One, it encourages government bureaucrats to adopt coercive means to get people to the camp, neglecting proper screening for the sterilization operation. Second, camp conditions badly compromise quality of healthcare. Women also need pre- and post-operative care that is rarely provided. A lot of NGOs and other organizations familiar with the realities of camps even question the quality of operative conditions of the camp. They mention that most sterilization camps become active only during November to March, with the accompanying mania to meet the targeted numbers. Some activists even report death during or after such operations; fortunately such incidents rare but are fully preventable with proper care.

You can solve the problem only if you understand it – this is the age old wisdom applicable everywhere.

While most Indian family planning officials are still obsessed by sterilization focused model of population management, there are some who know the ground reality. It is another story that their opinion does not count much. In their analysis, children born due to poor access to contraceptive services – demographers call it “unmet need” – are a major cause of India’s population boom. The birth of three or more children accounts for almost 45% of the 26 million births taking place each year. They also say that preference for a male child and the still high infant mortality rate account for another 20% of births.

In the light of these observations and the fact that population growth is predominantly momentum driven, it becomes clear what the policy makers of family welfare ministry should be doing.

1. Get rid of the obsession of female sterilization and sterilization camps, and take steps to reduce population momentum by the simple three step formula: (a) Discourage and prevent child marriages, (b) Encourage postponement of first pregnancy by two years after marriage, and (c) Increase availability of various contraceptives for spacing births.
2. Focus on increasing availability and access to contraceptive methods so that unwanted and unplanned pregnancies can be prevented (contributing 24% to population growth as per Visaria’s analysis). Condom awareness campaign should not be limited to HIV and STD prevention only. The young reproductive population needs range of contraceptive choices to prevent pregnancies more than the one time sterilization option.
3. Strengthen and make the family planning healthcare system comprehensive so that people not only get complete knowledge of all available contraceptive methods including IUCDs, pills, etc but also get counseling on their total reproductive health from a holistic angle.
4. If at all incentives have to be given, they should go to the people availing services – both governmental and non-governmental – and never to the bureaucrats in any form.
5. Allow sterilization camps only by NGOs and civil social organizations with complete freedom about pre- and post-operative care and camp duration.
6. Set up a system of quality monitoring of family planning healthcare system through a set of quality parameters, as oppose to the current fashion of counting sterilization numbers alone.
7. Female education and empowerment is the best contraceptive; include such programs too in the family planning healthcare system.

This article is inspired by the one day roundtable held in New Delhi (Jan 12, 2011) on “Population and family Planning: Contemporary Challenges & Opportunities”, organized by the National Coalition on Population Stabilization, Family Planning & Reproductive Rights. I gratefully acknowledge the resource material from the Center for Health and Social Justice (CHSJ), New Delhi, India.