Dialogue January-March, 2005,
Volume 6 No. 3
Current Thinking on Population Issues
The population issues in India have a number of dimensions. These include the current thinking and strategy, its past experience in family planning and population control; the evolution out its policies in this regard to the National Population Policy (2000).
At the outset it would be worth while to start the paper with a section “current thinking on population issues” as this is important to understand the issue of population and development in a correct perspective.
Current thinking on population issues
In the last half century there have been many changes in the thinking on population issues in India. From the mid 1950s, as a result of rapid fall in death rate there was an unprecedented high level of natural growth. It was this concern with the “excessive demographic increase” and its social, economic and perhaps geo-political ramifications that impelled the international community to focus on slowing down population growth by implementing what was then called “Population Control” or “Family Planning Programmes”. This was perhaps a spontaneous and logical response then on the part of international community trying to curb the increase in numbers from a “purely quantitative perspective”.
This “Neo-Malthusian” environment/situation continued in the 1960s, 1970s and throughout 1980s. Even in 1987 July 11th, when the world’s population crossed five billion mark, it was the concern with the rapidly increasing numbers which led to the observance of World Population Day. Apparently it was this fear of numbers that formed the core idea of the Population Programmes those days. The focus being mostly on “Population” and not the “People”. These programmes did not look at “Human Development” as the need of the hour, but instead looked at “Women” whose fertility needed to be controlled. The word “Control” best defined the situation.
It is only since 1994, after the International Conference on Population and Development (ICPD) at Cairo, (Egypt), that there has been a dramatic change in thinking on population issues. In fact ICPD formed a Watershed in the history of thinking on population issues. Indeed it would not be an exaggeration to suggest that ICPD was a sort of a New World Population Order. It brought about a significant shift in frameworks, strategies and approaches relating to population and public policy issues. It represented a paradigm shift from the previous emphasis on Demography and Population Control to Sustainable Development and Reproductive Rights. It emphasised that population was no longer about numbers, figures and statistics but about people and improving their quality of life. It required that for such a quality development to occur population programmes, should be development oriented, human rights based, inclusive and participatory and should involve the concerned people in the whole process. It was also agreed that no force, no coercion, no incentives and disincentives are required, because incentives and disincentives are either coercive or ultimately tend to be coercive and are in fact counter productive. Coercion infringes upon human rights and inhibits human development. The ICPD Programme of Action (PoA) placed “individuals” at the center of development with a focus on building pillars of “Human Development Rights, Gender Equity and Equality”.
The central theme of the ICPD was to forge a balance between population, sustained economic growth and sustainable development. The Programme of Action (PoA) rightly emphasized the inter-relationship of Population issues with goals of poverty eradication, food security, adequate shelter, employment and basic services (like health and education) for all. This, two fundamental changes have occurred in recent times in conceptualizing and implementing Population Policies. First is to ensure that Population Policies and Programmes address the root cause of high fertility such as persistent gender disparities in access to education, health, employment and other productive resources. The second is to expand existing Family Welfare Programmes beyond contraceptive delivery to include a range of Reproductive Health Services with a greater emphasis on quality of care and individual’s right.
The result is a broader and holistic approach. Earlier, Total Fertility Rate (TFR) and Contraceptive Prevalence Rate (CPR) used to be the fixation of most population programmes as they also served as indicators of success. ICPD replaced them with quality of care, informed choice, gender factor, women’s empowerment and accessibility to a whole gamut of reproductive health services. Use of words like “Population Control” or “Population Explosion” is now avoided as these have a negative connotation.
Family Planning Programme and Current Population Situation in India
India was the first country in the world to formulate a National Family Planning Programme in 1952, with the objective of “reducing birth rate to the extent necessary to stabilize the population at a level consistent with requirement of national economy”. Health care of women and children and provision of contraceptive services became the focus of India’s health programme. Successive Five Year Plans have been providing the policy framework and funding for planned development of nationwide health care infrastructure and manpower for provision of health care services.
The technological advances and improved quality and converge of health care resulted in a rapid fall in Crude Death Rate (CDR) from 25.1 in 1951 to 9.8 in 1991. In contrast, the reduction in Crude Birth Rate (CBR) has been less steep, declining from 40.8 in 1951 to 29.5 in 1991. As a result, the annual exponential population growth rate has been over 2% in the period between 1971-1991. India while celebrating its golden Jubilee of Independence in 1997 made a commitment to accelerate the process of population stabilization. India had already become, by then, a signatory to the Programme of Action (PoA) of International Conference on Population and Development (ICPD) held in Cairo in 1994, and committed to a new holistic programme of Reproductive and Child Health (RCH), in October 1997. The essential components undertaken for nationwide implementation include:-
l Prevention and management of unwanted pregnancy
l Services to promote safe motherhood
l Services to promote child survival
l Prevention and treatment of RTI/STI
Efforts were made to provide adequate inputs to improve availability and access RCH services and to improve performance especially in the states/districts where access to RCH services is sub optimal. Attempts to reduce disparities between states/districts and achieve tangible improvement in the indices by replication of better performing districts were encouraged.
Current Population Situation :
l As per Census of India 2001, India’s population on March 1, 2001 was 1028 million. Viewed globally, India constitutes 16.87% of the World Population. The current population (estimate) is about 1111 million
l The current high population growth rate in some parts of the country is due to:
Ä The large size of the population in the reproductive age group (estimated contribution 60%).
Ä Higher fertility due to unmet need for contraception (estimated contribution 20%)
Ä High wanted fertility due to prevailing high Infant Mortality Rate (IMR) (estimated contribution about 20%).
India’s Demographic Progress :
Sr. Parameter 1951 1981 1991 Current NPP –
No. Goals
for
2010
1. Population 361 483 846 1028 1107
(in million) (2001
Census)
1111 Current
(estimate)
2. Crude Birth Rate 40.8 33.9 29.5 28.8 21
(per 1000 (SRS) (SRS) (SRS
population) 2000)
3. Total Fertility Rate 6.0 4.5 3.6 2.9 2.1
(SRS) (SRS) (NFHS
98-99) Contd.
Sr. Parameter 1951 1981 1991 Current NPP –
No. Goals
for
2010
4. Maternal Mortality NA NA 437 407 100
Ratio (per 100,000 (92-93) (1998)
live births)
5. Infant Mortality 146 110 80 63 Below
Rate (per 1000 (1951- (SRS) (SRS) (SRS- 30
live births) 61) 2002)
6. Literacy Rate
Persons 18.33 43.57 52.21 65.38
Males 27.16 56.38 64.13 75.85
Females 8.86 29.76 39.29 54.16
7. Contraceptive 10.4 22.8 44.1 48.2 To
Prevalence (1971) (NFHS- meet
Rate % 98-99) all
needs
8. Full Immunization
of infants (from
6 vaccine
preventable
diseases) 56% 100%
9. ANC checkup 43.8% 100%
(3 visits)
10. Institutional 34% 80%
Deliveries
Evolution of India’s Family Planning Programmes
The major milestones in the Evolution of India’s Family Planning Programmes since independence are as follows:
l 1952 The Fist Five Year Plan document noted the “urgency of the problems of family planning and population control’ and advocated a reduction in the birth rate to stabilize population at a level consistent with the needs of the economy.
l 1956 The Second Five Year Plan proposed expansion of family planning clinics in both rural and urban areas and recommended a more or less autonomous Central Family Planning Board, with similar state level boards.
l 1961 The Third Five Year Plan envisaged the provision of sterilization facilities in district hospitals, sub-divisional hospitals and primary health centers as a part of the family planning programme. Maharashtra state organized “Sterilization Camps” in rural areas.
l 1963 The Director of Family Planning proposed a shift from the clinic approach to a community extension approach to be implemented by auxiliary nurse midwives (one per 10,000 population) located in PHCs. Other proposals include : (a) a goal of lowering the birth rate from an estimated 40 to 25 by 1973; and (b) a cafeteria approach to the provision of contraceptive methods, wit an emphasis on free choice.
l 1965 The Intra Uterine Device (IUD) was introduced in the Indian Family Planning Programme.
l 1966 A full-fledged Department of Family Planning was set up in the Ministry of Health. Condoms began to be distributed through the established channels of leading distributors of consumer goods.
l In 1976, during emergency, the Congress Government under Smt. Indira Gandhi formulated a Population Policy (in a form of Policy Statement) which became counter-productive because of a clause, which permitted States to go for Compulsory Sterilization.
l In 1977, A revised population policy statement was tabled in Parliament by the Janata Government. It emphasized the voluntary nature of the “Family Planning” programme. The term “Family Welfare” replaced Family Planning.
l In 1983 National Health Policy was announced in which mention was made in passing about Population and Family Welfare Programmes.
l In 1991, the Government under Shri Narasimha Rao appointed a Committee headed by Shri K Karunakaran, which submitted a report to the National Development Council in 1993 in which it pleaded for National Population Policy.
l In 1993, the Government appointed Dr. M S Swaminathan as Chairman of an Expert Group to draft a Population Policy. The draft Population Policy was submitted to the then P M in 1994, which was subsequently tabled in Parliament but could not be passed.
l Again in 1997, an Attempt was made by the Government under Shri I K Gujaral to table and get the Population Policy passed. However, it could not be done.
l In 1999 the Government, under Shri A B Vajpayee, asked a Group of Ministers to examine the Policy draft prepared by the Department of Family Welfare, Ministry of Health & Family Welfare.
l In February 2000, the Government of India announced the National Population Policy (NPP), 2000
National Population Policy, 2000 (NPP-2000)
The overriding objective of the National Population Policy in February 2000 is economic and social development and to improve the quality of life that people lead, to enhance their well-being, and to provide them with opportunities and choices to become productive assets in society. It is an articulation of India’s commitment to the ICPD agenda. The Policy also affirms the commitment of Government towards voluntary and informed choice and consent of citizens while availing of reproductive health care services and continuation of the target free approach in administering family planning services with multiple choices.
The NPP 2000 provides a Policy framework for advancing goals and prioritizing strategies during the next decade to meet the reproductive and child health needs of the people of India and to achieve net replacement levels (TFR of 2.1) by 2010. Some of the major socio-demographic goals to be achieved by 2010, is expected to lead to stable population by 2045. These are:
1. To meet the demands in full for basic reproductive and child health services, supplies and infrastructure.
2. Reducing infant mortality rate to below 30 per 1000 live births
3. Reducing maternal mortality to below 100 per one lakh live births
4. Achieving universal immunization of children against all vaccine preventable diseases
5. Achieving 80% institutional deliveries and 100% deliveries by trained persons
6. Increasing use of contraceptives with a wide basket of choices
7. Achieving 100% registration of births, deaths, marriages and pregnancies
8. Integrating Indian System of medicines in providing reproductive and child health services
9. Promoting small family norm to achieve replacement levels of fertility by 2010
10. Making school education up to age 14 free and compulsory and reduce drop out at primary and secondary school levels.
11. Promoting delayed marriage for girls
12. Bringing about convergences in implementation of related social sector programmes so that family welfare becomes a people’s centered programme
In order to achieve, the above national socio-demographic goals by 2010 the following 12 strategic themes have been identified. These are:
1. Decentralized planning and program implementation
2. Convergence of Service delivery at village levels
3. Empowering women for improved Health and nutrition
4. Child Survival and Child Health
5. Meeting the unmet needs for family welfare services.
6. Under-served population groups:
(a) Urban slums;
(b) Tribal communities, hill area population and displaced and migrant populations;
(c) Adolescents;
(d) Increased participation of men in planned parenthood
7. Diverse health care providers.
8. Collaboration with and commitments from non-government organizations and the private sector;
9. Mainstreaming Indian Systems of Medicine and Homeopathy;
10. Contraceptive technology and research on reproductive and child health
11. Providing for the older population.
12. Information, Education and Communication
Population stabilization efforts are a matter of priority for the government. This is reflected in the fact that Prime Minister of India heads the National Commission on Population (NCP), which was constituted on 11th May 2000. The Commission is to review, monitor and give direction for implementation of the National Population Policy with a view to achieve the goals set in the Population Policy.
Substantial differences are visible between states in the achievement of basic demographic indices. This has led to significant disparity in current population size and the potential to influence population increase. There are wide inter-state, male-female and rural-urban disparities in outcomes and impacts. These differences stem largely from poverty, illiteracy, and inadequate access to health and family welfare services, which co-exist and reinforce each other.
The States of Tamil Nadu, Kerala, Goa, Nagaland, Delhi, Pondicherry, A & N Islands, Chandigarh, Mizoram have already achieved replacement levels of fertility (total fertility rate of 2.1).
Karnataka, Andhra Pradesh, West Bengal, Maharashtra, Punjab, Himachal Pradesh, Manipur, Arunachal Pradesh, Lakshwadweep, Daman and Diu and Sikkim have total fertility rate of more than 2.1 but less than 3.0.
Uttar Pradesh, Madhya Pradesh,
Bihar, Rajashtan, Orissa, Assam, Haryana, Gujarat, Tripura, Meghalaya, Jammu &
Kashmir, Dadra and Nagar Haveli have total fertility rate of over 3. Demographic
outcomes in these States will determine the timing and size of population at
which India achieves population stabilization.
Several states
have demonstrated that the steep reduction in mortality and fertility envisaged
in the NPP 2000 are technically feasible within the existing infrastructure and
manpower. All efforts are being made to enhance resources, provide essential
supplies, improve efficiency and ensure accountability – especially in the
states where performance of socio demographic indicators is currently
sub-optimal – so that there is tangible improvement in the performance. An
Empowered Action Group (EAG) has been constituted to design and formulate
programmes in terms of geographic and thematic areas with a special focus on the
needs and to facilitate capacity building in these states.