Narendra Modi, in his Independence Day speech, for the first time commented on India's burgeoning population, calling those who are “self-motivated” to limit family sizes, true patriots. “It is about how children have got education, how the family is free from disease and how well the family fulfils their primary needs,” Modi said.
The mission to control population growth, however, is being pursued since India got independence from the British, when the population was 342 million. The country’s first family planning programme was put into place by 1952, while a family planning department was constituted under the Ministry of Health in 1966. This covered initially birth control programmes and later included under its wing, mother and child health, nutrition and family welfare.
Matters turned awry during Indira Gandhi’s tenure as prime minister during the middle of 1970s, when the family planning programme meant to encourage men and women of reproductive age to undergo state-sponsored vasectomy procedures, ended up in forced sterilisation of over six million men.
It was this move that led to the Congress government’s defeat in Lok Sabha polls, which brought Morarji Desai’s government to power. Under Desai in 1977, the term ‘family planning’ was replaced in relevant architecture with ‘family welfare’ and the new population control policy was voluntary, not compulsory.
A study by the UN Population Fund titled Demographic Dividend in India projects that by 2060, India’s population is expected to touch 166 crore. Meanwhile, United Nations’ The World Population Prospects 2019 estimated that India’s population will surpass that of China by 2027. The fate of the sterilisation drive under Indira Gandhi’s leadership shows that coercive methods, such as The Population Regulation Bill, 2019 introduced by Rajya Sabha member Rakesh Sinha, may not be the solution to the problem. One of the sections of this Bill lays down provisions for punitive action against people with more than two living children.
In fact, China’s one-child-per-couple police and then its two-child policy in 2015 is a warning sign against robbing people of their choices when it comes to family planning and welfare. The law resulted in forced sterilizations, abortions, abandonment of girl children, falling birth rates, skewed sex ratios, a rapidly growing ageing population and a shrinking workforce. By 2016, there were 1.15 males for every female in China, one of the most skewed gender ratios in the world.
Following the sterilisation drive in the 1970s, the focus of family planning programmes shifted to women, a trend which continues till today’s time, but continues to have its repercussions. In 2014, 15 women died in Chhattisgarh and 20 remained in intensive care after surgery at two government-run sterilisation camps. These women were to get an incentive of about Rs 1,400 each. Later, local officials in Chhattisgarh said they were given a target by central government of 2,20,000 sterilisations a year, including 15,000 in Bilaspur, the district where the botched surgeries took place.
According to PIL cited by a report in Caravan, surgeries were conducted on women at a breakneck pace to meet targets set by the Rajasthan government, the first to adopt the two-child norm in 1992. According to research from the state’s Bundi district, 88 percent of the women were not informed about the likelihood of failure, complications and side effects after sterilisation. 42 percent of the women were not told that sterilisation is permanent. Around 60 percent of women were unaware that sterilisation surgery can cause complications and, in some cases, death.
In Bihar, in January 2012, 53 women were operated upon by one doctor at Kaparfora Government Middle School in the state’s Araria district at night under torchlight within two hours. The doctor did not wash hands, change gloves, or wear a surgical gown and cap during the surgeries, and NGO workers placed the women on straw paddy. When the camp concluded, three women were left with heavy bleeding, the Caravan report said. India has one of the world’s highest rates of female sterilisations, with about 37 percent of women having the operations, compared to 29 percent in China, according to the UN. About 4.6 million Indian women were sterilised in 2011 and 2012. In 2013-14, India carried out nearly 40 lakh sterilisations, according to official figures reported by BBC. Less than 1,00,000 of these surgeries were done on men.
While Modi may be aiming at voluntary population control to ensure a faster rise in per capita incomes, what has to be remembered is ensuring women's access to contraceptives. About three crore women could not access contraceptives in 2015-16, as per National Family Health Survey (NFHS 4), making it difficult for them to plan pregnancies. What makes the crisis worse is that family planning component receives merely four percent of the total budget allocated for National Health Mission Reproductive and Child Health. Additionally, around 40 percent of the total funds made available for family planning in 2016-17 were not even spent.
The connections between health, education and inequality have a significant role to play in the awareness of available choices when it comes to family planning and welfare. NFHS 4 noted that the women in the lowest wealth quintile have an average of 1.6 more children than women in the highest wealth quintile. Also, women with no schooling have an average 3.1 children, compared to 1.7 children for women with 12 or more years of schooling.
The pattern of contraceptive usage is skewed, with men not taking up the responsibility of managing fertility. The most popular contraceptive method is female sterilization (36 percent), while male sterilization accounts for a mere 0.3 percent. Only 54 percent of women were informed of other available contraceptive methods while 47 percent of women were informed of the possible side effects of their chosen method.
The NFHS 4 and 2011 Census data point to a silver lining though. The 2011 Census data showed a 3.9 percent decline in growth in the 2001-2011 period from the previous 1991-2001 period. While population is increasing, India’s total fertility rate (or the number of children borne by a woman) has declined sharply — from 2.7 in 2005-06 to 2.2 in 2015-16, with all but seven states are on the verge of achieving population stabilisation, the NFHS 4 found. A country’s ideal fertility rate is 2.1. Thus, even as population grows, it will comprise of a larger work force between 15 and 59 years.
Kerala, Tamil Nadu, Himachal Pradesh, West Bengal, Punjab, Maharashtra, Assam and many other states have already managed to bring their growth to replacement rate, Down To Earth reported. Replacement rate refers to the total fertility rate that will result in a stable population without it increasing or decreasing. States like Bihar, Uttar Pradesh, Rajasthan and Haryana, which were lagging behind, will rapidly move towards achieving the replacement level. 24 states including Himachal Pradesh, West Bengal, Maharashtra, Punjab and southern states have achieved fertility rates well below the replacement rate. But, not a single state out of all 24 that have achieved the replacement level total fertility rate of 2.1 has used any coercive methods.
The Indian government signed the International Conference on Population and Development declaration in 1994, which means it cannot implement a two-child policy. The declaration advocates free speech and honours the reproductive rights of couples to decide freely and responsibly the number and spacing of children. India’s own National Population Policy (2000) reiterates government’s resolve for voluntary and informed choice in matters of family planning while availing of reproductive health care services” along with a “target free approach in administering family planning services”.
India’s then health minister Karan Singh had said at the World Population Conference in Bucharest in 1974 that “development is the best contraceptive”. However, population control is a process required stringent public awareness programs and public participation. Gender inequality, poverty, lack of women’s access to contraception contribute to poor family planning practices. The government’s seriousness in pursuing the issue will be reflected by investment in family planning programmes and ensuring their reach to people and success.
Updated Date: Aug 17, 2019 09:09:48 IST