According to the latest National Family Health Survey (NFHS) released by the Union Health Ministry, coming on the back of a sustained family planning programme spanning decades, the Total Fertility Rate (TFR), or the average number of children per woman, has declined further from 2.2 reported in 2015-16 to 2.0 at the all-India level
According to the United Nations’ population division, countries experiencing below-replacement fertility — lower than 2.1 children per woman — indicates that a generation is not producing enough children to replace itself, eventually leading to an outright reduction in population.
The data in NFHS 2019-21, the fifth in the survey series, shows the fertility rate at 1.6 per cent in urban areas and 2.1 in rural India.
TFR indicates the average number of children expected to be born to a woman during her reproductive span of 15-49 years.
The replacement level is the number of children needed to replace the parents, after accounting for fatalities, skewed sex ratio, infant mortality, etc. Population starts falling below this level.
- Director at International Institute for Population Sciences, which is the designated nodal agency to conduct NFHS-5, told that a TFR of 2 is a “definite indicator” of stability of population in the long term in the country.
- “The number means two parents are replacing two children. In the long run, we will have a potential growth rate of zero. It is not immediate.
- A TFR of 2.1 is something a country wants to achieve. That way it is a very huge development because of maternal and child health improvement.
- Top public health experts highlighted three key pointers from the TFR declining to 2: a diminished challenge to development, the importance of investing in public health and education with skills, and the need to focus on environmental protection.
- The country has been aiming for a TFR of 2.1. A fall to 2 means we have achieved our goal of population stabilization.
- This means we will possibly still become the most populous country in the world — it was expected somewhere between 2024-2028 — but it will now be delayed.
- It essentially means that we need not worry about a very large population being a challenge to our development.
- The numbers also tell us that we have stabilised the growth of human resources.
- The younger population profile for the next 2-3 decades will provide an opportunity for accelerated economic growth.
- But continuing to have a young population for 2-3 decades, along with population stabilization, should give us a great opportunity for accelerated development — provided we invest in public health and education with skills.
- Importantly, we can no longer say that due to population growth, there is strain on our natural resources. Now if we are stabilising the population, there is really no excuse for neglecting the environment.
Area-specific approach needs to adopt:
- According to the survey, there are five states with TFR above 2: Bihar (3), Meghalaya (2.9), Uttar Pradesh (2.4), Jharkhand (2.3) and Manipur (2.2).
- Two states reported TFR at the same level as the national average: Madhya Pradesh and Rajasthan. Two states have a TFR of 1.6: West Bengal and Maharashtra.
- Six states have a TFR of 1.7: Maharashtra, Karnataka, Andhra Pradesh, Himachal Pradesh, Nagaland and Tripura.
- Six more states have a TFR of 1.8: Kerala, Tamil Nadu, Telangana, Arunachal Pradesh, Chhattisgarh and Odisha. And five states have a TFR of 1.9: Haryana, Assam, Gujarat, Uttarakhand and Mizoram.
- The latest data also show significant progress on several indicators related to fertility, family planning, age at marriage and women’s empowerment — all of which have contributed to the decrease in TFR.
NFHS-5 finds that there has been a significant increase in current use of any modern contraceptive method, which stands at 56.5 per cent in 2019-21 against 47.8 per cent in 2015-16. The share of condoms is 9.5 per cent against 5.6 per cent in 2015-16.
However, the uptake of female sterilisation has gone up to 38 per cent against 36 per cent in 2015-16.
The uptake of injectable contraceptives, introduced in 2017, remains abysmally low at 0.6 per cent.
The increase in female sterilisation shows that the onus of family planning remains with women, with men not participating in the process and “shrugging responisbility’’.
- The Government must adopt a targeted social and behavior-change communication strategy to ensure that men also take responsibility for family planning.
- But the increased use of modern contraception also means that the total unmet need for family planning, which has been a major issue in the past, has come down to 9.4 per cent in 2019-21 against 12.9 per cent in 2015-16.
- It is less than 10 per cent for all states except Jharkhand (12 per cent), Arunachal Pradesh (13 per cent) and Uttar Pradesh (13 per cent).
- India needs to focus on some areas which are socially, culturally, economically depressed.
- Identification of 140 high focused districts is the right step by the government in this direction. However, it needs to work in the whole of Bihar, U.P., Madhya Pradesh and Assam.
- The quality of care in family planning has shown significant improvement with 62 per cent of current users reporting that they received information on side effects from service providers.
- This has increased from 46 per cent in the last survey. The number of women who have a bank account they operate themselves has increased significantly from 53 per cent in 2015-16 to 79 percent.
- Decentralized policies targeted at states such as Bihar, Meghalaya, Uttar Pradesh and Jharkhand, which require special focus to lower the fertility levels, can be implemented on a priority basis.
India needs to invest more in the health sector. India invests only 1.3% of its GDP. The family planning budget is only 4% of the entire health budget and within that India spends only 1.5% on birth spacing methods.
We need to invest heavily in human capital, health and education for a healthy and productive population that can add to national and global accomplishments of the country.
Task shifting and empowering primary health centre personnel with resources to carry out a sustained result-driven campaign to help spread the message of family planning techniques and benefits of a smaller family, along with quality investments in female education, could help India attain uniform fertility levels across all states at a faster pace.