On the whole, family planning programmes have done well in tackling India’s fertility challenge. The recently released report on the fourth round of the National Family Health Survey (NFHS-4), carried out in 2015-16, shows where it has succeeded—and where shortcomings remain.
- Social reformer Raghunath Dhondo Karve was well ahead of his time when he pioneered family planning in Mumbai in the 1920s.
- Independent India’s first government caught up in 1952 when it started the world’s first family planning programme.
- There have been missteps too such as Sanjay Gandhi’s forced sterilisation drive.
- It took the Supreme Court, in its 2016 verdict in Devika Biswas vs Union of India & Others, to call for an end to sterilisation
Details of the report –
The total fertility rate has declined to 2.2, marginally above the replacement rate of 2.1. This is substantial progress from 2005-2006 when NFHS-3 pegged the rate at 2.7.
Analysis of the report –
There are a number of takeaways from slicing the numbers in different ways.
- Geographic variance -The fertility rate in 23 states and Union territories—including all the southern states—is below the replacement rate. It is substantially higher in a number of states in central, east and north-east India. The most effective way of enabling fertility-related public health is a greater role for local bodies in both urban and rural areas—an item on the incomplete devolution agenda.
- Characteristic background of female respondents – Education is a clear differentiator. Women with 12 years or more of schooling have a fertility rate of 1.7, while women with no schooling have an average rate of 3.1. The corresponding rate for women with 12 years or more of schooling was 2%.
- Education – Higher levels of schooling mean lower levels of teenage pregnancy. In the 15-19 cohort, as many as one-fifth of the women with no schooling have begun childbearing, while only one in 25 women in the same cohort who have had 12 years or more of schooling have done so.
- Contraceptive usage – Knowledge of contraceptive methods is now almost universal in India; the government has done well here. Despite this, men have not taken up the responsibility of managing fertility. The most popular contraceptive method by far, at 36%, is female sterilisation. Male sterilisation—a less invasive and easier method with a much lower chance of medical complications—accounts for a mere 0.3%.
- Lack of education robs women of reproductive control, feeding into India’s maternal and child health problem.
- Lack of education when combined with younger pregnancies and higher childbearing rates, it also constrains women’s economic choices.
- All this reinforces a lack of reproductive control—44% of women who are unemployed use modern contraceptives while 60% of women who are employed for cash do so—perpetuating a vicious cycle.
Way forward –
- The National Population Policy (NPP) of 2000 explicitly rejected the numbers game—the targeted approach that had dominated fertility management until then. It leads to forced sterilisations and does not encourage behavioural change. Unfortunately, the National Health Policy has set up a fertility rate target again.
- Karve took the radical view that women could best confront the fertility challenge via emancipation and gender equality. That continues to hold true today.
- Successive governments have done well over the decades; NFHS-4 shows improvement in almost all metrics from the 2005-06 NFHS-3. Now, they must focus on enabling educational and economic opportunities for women.
What is fertility rate?
Births per 1000 women, categorised according to a specific composition of mothers in the population –
- Crude birth rate: number of live births per 1000 of the population.
- General fertility rate: number of live births per 1000 women between the ages of 15 and 44 years.
The recently released report on the fourth round of the National Family Health Survey (NFHS-4), carried out in 2015-16 has flagged the multiple challenges that confront India’s family planning objectives set out in National Health Policy 2017. Let us look at the report in detail.
The objective to achieve better family planning in India rests on the first step of enabling educational and economic opportunities for women. Discuss this statement in light of the recently released National Family Health Survey (NFHS-4).