How did India achieve to decrease its TFR below replacement level according to the new NFHS-5 Data?
The decline in TFR, as reported by NFHS-5 is a result of the progress made in various aspects of health and development, particularly, the increased uptake of family planning methods, secondary school education among women and greater autonomy among women. It reflects the outcome of the continued efforts by the government to improve public health, especially family planning services, maternal and child health services in both urban and rural areas. Women are increasingly preferring to have less than two children, with the overall Wanted Fertility Rate among women in India being 1.8 according to NFHS-4 of 2015-16. An increase in the number of educated women is reducing the overall TFR. The Government of India’s strategy to push for increased uptake of family planning services in 146 high fertility districts through Mission Parivar Vikas and introduction of three new contraceptive methods in the public health system and education and behaviour change communication programmes by government and non-government stakeholders have yielded positive results.
Earlier there was a concern that India would surpass China and become the most populated country, do you think population myth is broken now with encouraging data from NFHS-5?
India, with a current population size of 1.37 billion, has the second largest population in the world. By 2027, India was expected to overtake China to become the most populous country (UN World Population Prospects 2019). However, going by the current trends in TFR and especially with a much-reduced urban TFR, India will take a little longer to become the most populous country in the world.
A study by Institute for Health Metrics and Evaluation (IHME), University of Washington, Seattle, published in The Lancet indicates that India is expected to reach its peak population of 1.6 billion by 2048. India is also projected to have a continued steep decline in total fertility rate which will reach to 1.3 along with a total population of 1.1 billion in 2100. At the same time, evidence also suggests a downward trend in population growth rate. An analysis of the Indian Census data on population confirms a declining growth rate over the decades among all religious groups. The decadal growth rate i.e. the population growth rate over the 10-year period, declined from 21.5% over 1991-2001 to 17.7% in 2001-2011. (Census 2011).
India’s overall population size will not shrink immediately as the country is experiencing a population momentum as a result of a demographic transition. India has a high proportion (about 30.9%) of young persons in the age 10-24 years who are in the reproductive age group or will soon be. Even if this cohort produces one or two children per couple there will still be a quantum increase in total population because of their high number. Replacement level fertility therefore leads to zero population growth only in the long run. Thus, India with its large proportion of young persons will take some time to stablise its population.
What is lacking in certain states which has shown less use of contraceptives and larger population numbers compared to the other states?
Different Indian states are at different stages of demographic transition. For instance, states in the south have already achieved replacement level TFR. On the other hand, only Bihar (3.0), Meghalaya (2.9), Uttar Pradesh (2.4), Jharkhand (2.3) and Manipur (2.2) have TFR above the replacement level, according to NFHS5. Fertility decline has a direct relationship with education levels, particularly of women, access to health services, particularly family planning services as well as women’s empowerment.
In five states where the TFR is still higher than 2.1, their unmet need for family planning methods are also more than the national average. Meghalaya (26.9%), Bihar (13.6%), and Uttar Pradesh (12.9%) reported the highest total unmet need for family planning in the country in 2019-20. In order to address the interstate and interregional variations in fertility, there is an urgent need to strengthen access and reach of family planning and sexual and reproductive health services, education and overall development. In addition, targeted social and behaviour change communication strategies which address the social determinants of health are also imperative.
Can we assume that India has course corrected itself from population control?
There is enough evidence to prove that there is no population explosion in the country and India has achieved replacement level fertility without the introduction of coercive population policies. In order to sustain the progress made, continued investments in health, education and employment should be the way forward.
Why has India not made progress on anaemia and childhood wasting? It’s rising in women and children.
The recent National Family Health Survey 5 reveals that anaemia has increased across all age groups in the population – children, men and women. Anaemia among women in the age group 15-49 years have increased from 53.2% in 2015-16 to 57.2% in 2019-20. It is much more rampant among adolescent girls in the age group 15-19 years (59.1%) and children (67.1%). Anaemia levels among men though comparatively lesser than women and children have also increased from 22.7% in 2015-16 to 25% 2019-20 and is higher among adolescent boys (31.1%).
The rising levels in anaemia reveals that there is a need for a renewed focus on addressing micronutrient deficiency through programmatic efforts. The strategies implemented so far largely focus on the use of supplemental sources or fortified foods in alleviating the burden of micronutrient deficiencies. While evidence from the NFHS-5 largely pertains to the pre-pandemic period, the pandemic and subsequent disruptions in coverage of essential nutrition services and reduction in food security could have far reaching consequences. Malnutrition and micronutrient deficiencies affect not only people’s physical growth, cognitive development, overall capacity and increased disease burden, but also compromises the health of the future generations and limits India’s global economic potential. The National Nutrition Mission guidelines recognises the need for greater private sector engagement to improve nutrition outcomes of people. Therefore, tackling India’s nutrition challenge necessitates a comprehensive and concerted response with active participation from different stakeholders along with the government to address both demand and supply side requirements.