India Will Have Largest Population But Data Show The Growth Is Slowing

India will thus become the most populous country next year and is expected to reach a total population of 1.5 billion by 2030 and 1.66 billion by 2050, the UN said. To discuss the social implications, we spoke with Muttreja, who has a Master's in Public Administration from Harvard University, USA and has spent over 40 years in various roles in India's development sector.

India Will Have Largest Population But Data Show The Growth Is Slowing



Even if all these millions of young people have just one child, India's population is going to grow, says Muttreja. But India did not need a UN report for this, as its own data, from the National Family Health Survey, and the Census, already show what direction the country was headed, she explained. "Why express shock as a nation that we are overtaking China, or our population is increasing in terms of numbers?"

Muttreja talks about what India must do to avoid demographic disaster, why women need easier access to contraception, and why men need to be involved in family planning.

Edited excerpts:

Let's look at India's population growth numbers in terms of our own resources and our ability to provide good social and economic prospects, including job opportunities, to our young population. Where do we stand right now in terms of our capability of providing these resources to manage a growing population?

I give India literally three or four out of 10, and I'll explain why. We in India knew where we stood in terms of demographics and numbers, and in which direction we were going, but we have done very little to invest in either health or education or skill development. We talk a lot about skill development and India's demographic dividend, as though it's an automatic thing that will happen. Though there is a window of opportunity we still have [to reap the demographic dividend], it's limited. It won't last forever.

About 15 years ago, we got a study done which showed that only 2% of Indians had the skills and capabilities of entering the job market, where the good job opportunities exist. That hasn't improved very much, if you look at the numbers. It could be 3% by now, but it is still dismally low.

Second, where is our investment in health? We invest 1.4% [instead of] 3% of our gross domestic product in health. The previous and current government have talked about increasing investments in health. But within the health sector, [family planning accounts for] a meagre 6% of the meagre health budget. We don't even invest much in temporary [family planning] methods, which is what young people who want to postpone having children or to space [apart] childbirth, need. Why do we invest 85% of our [family planning] expenditure in permanent methods, which is sterilisation? Around 77% of Indian women who undergo sterilisation have never had prior experience with temporary methods of family planning.

In education, I think India has made some progress, though we need to do a lot more. I'm not going to talk about learning achievements, but just in terms of the fact that if a woman is educated up to class 12, she'll have fewer children, i.e. two or less, and if she has lesser education, she will have three or more children. So there, we've made some progress.

You also spoke about population growth slowing down, globally as well as in India. Can you put that in context for us? Why do you say we shouldn't worry too much about this?

Thirty one states and Union territories in India have reached the [population] replacement level of 2.1. When I say replacement level, I'm referring to two children born to replace two parents. There are five states in India which have rapid population growth, of which two, Bihar and Uttar Pradesh, need investments in population stabilisation, not coercion and incentives and disincentives. I can tell you that the latest NFHS data show that they are also making progress. Fertility rates are coming down in both Uttar Pradesh and Bihar.

In the short term, it is a good thing. But in the long run, it means our population will stabilise by 2050, which is what both the Indian government projects and international data show. In that case, we will begin to have an adverse [dependency] ratio between older generations and young people. This means we will have fewer young people and more older people, thus we will not have enough young people to look after older people. Plus, we don't have social security in India at all, in any form, especially for the aged. That is going to be a problem. Also, in about 20 years, if we don't skill our young people and create jobs, there's going to be a demographic disaster.

Why is it that population growth is slowing down, whether in India or elsewhere?

Let me talk about India first. In India, population growth is slowing because people want fewer children. Frankly, women across the world want fewer children. In India, the 'wanted fertility rate' is 1.8. Data in 2015 showed 16 million abortions, but this would have increased, and as we don't have a subsequent assessment, I would imagine that we are close to 20 million per year now. I think it's a big shame and I feel very upset about the fact that women should have to use abortion as a proxy for contraception. It shows you the desperation.

Then, if you look at the most recent NFHS data, the unmet need for family planning in India--i.e. people who desire to have fewer children and are not able to because they don't have access to or the agency to opt for family planning--is still 10%. No child should be an unwanted child. In fact, an unwanted, unexpected, or unplanned child has a 50% higher chance of being malnourished. [India also had] high under-five mortality rates.

Further, women or families wish to have fewer children [because] they can't afford to feed children anymore, leave alone educate them. Look at the food inflation rates in India.

Finally, the marginalised and poor people in terms of education and incomes, now know how the better-off half lives, thanks to the media. They recognise that the better-off have one or two children, and invest in them. So they too wish to have more education and better lives for fewer children.

Another reason is that fertility has declined because the age at marriage is increasing. Not sufficiently, as one in five girls still gets married below the legal age, but we have made some progress.

How should we be broadly preparing to become the most populous nation in the world? To what extent will this be an opportunity, and to what extent will it be a challenge? How do we manage our resources as a country going forward?

I would like to see this as an opportunity for us to invest more in family planning and more methods [of family planning]. Every time you add a new method, the use of contraceptives increases by 6% to 12%, and fertility declines. In our whole region, I would say, India has the fewest number of contraceptive methods. India needs to bring in the technology which the world is using. We are yet to introduce implants, which is a very suitable method for people who are planning families or who want to space their children. There is also this hormonal method with which pregnancy can be prevented from three to five years. There's one method for [delaying for] three years and one for five years. It is something for which women don't need permission from or consensus within the family, unlike for sterilisation.

I can name any number of countries in our neighbourhood where fertility decline has taken place on the basis of introducing new modern methods. India needs to do that. India needs to spend more money on temporary methods of family planning. India needs to, without coercion, involve and engage its men in family planning. Men do not take responsibility for family planning or for having children. I always say for men, it's about sex, and for women, it's about getting pregnant and having families. So we need more male methods. But of the male family planning methods that exist, which are condoms and sterilisation, just 0.3% of Indian men opt for sterilisation while among women, it's about 50%.

You're saying that reaching this landmark of the world's largest country by population is an opportunity to really step up the efforts on population management, but we've tried this before as well. So are you advocating a more stringent focus on this?

Coercion will not work in India. Even if we succeed in coercing some people, we are going to have adverse sex ratios because of male preference and daughter aversion in India. China has male preference but they don't have daughter aversion, as we do. As it is, our sex ratios are adverse and they will decline much further [with coercive methods of population control].

Two other points I want to add: first, we need sex education. We need to make our young people not just aware of contraceptives, but about issues around planning for their lives, for their education, and how early marriage and early childbirth impacts this. We need to do comprehensive sex education and create awareness in schools.

Second, we need young people to have more access to contraceptives. Even today, an ANM [auxiliary nurse midwife] or ASHA [accredited social health activist] worker, who belongs to the same community and shares the same social norms, doesn't encourage family planning or give young people access to contraception. Not even newly married couples; I'm not talking about single people. Young, newly married couples are always told that they don't need contraception, they need to prove their fertility.

Also, as we discussed earlier, we need to invest in both education and skill development of young people more seriously in a mission mode. This government has shown that what it is determined to do, it does do. There has to be determination.

Finally, we have to stop diverting the issue by saying there's a population bomb and we need coercion. We can't just stop there. We need to do all these other things. Just coercion is going to get us nowhere.

References:

Dr Rohit Bhaskar, Physio
Dr Rohit Bhaskar, Physio Dr. Rohit Bhaskar, Physio is Founder of Bhaskar Health and Physiotherapy and is also a consulting physiotherapist. He completed his Graduation in Physiotherapy from Uttar Pradesh University of Medical Sciences. His clinical interests are in Chest Physiotherapy, stroke rehab, parkinson’s and head injury rehab. Bhaskar Health is dedicated to readers, doctors, physiotherapists, nurses, paramedics, pharmacists and other healthcare professionals. Bhaskar Health audience is the reason I feel so passionate about this project, so thanks for reading and sharing Bhaskar Health.

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