Should the state stop focusing on population control?

India started its national program for family planning in 1952. What are the factors that have helped the country bring down its TFR?

Poonam Mutreja: Yes, it was good that India got off to an early start. But while India has the oldest family planning programme, it does not have the best or even an average programme. First of all I would like to give credit to the women and their aspirations. Men have demonstrated that they are not responsible for family planning and rarely support women in family planning decisions. The decline is on expected lines. If you look at NFHS-4, women wanted an average of 1.8 children. So, it’s just that we have a great need for family planning. In NFHS-4 it was 13%. In NFHS-5, it has come down to an average of close to 10% in many states. There are 16.4 million abortions every year, which I think is an underestimate and a proxy for contraception. Hence, there is determination in India despite men not participating. Having said that, I would like to say that in the last five or six years, we have introduced new methods, however we need to do much better on numbers and we need more tentative methods. Another reason women want to have or have fewer children is education. It’s the best birth control pill, and better education means women will have fewer children. There are many reasons for the decline in TFR, but I would like to give the most credit to women. Also, fertility has declined on religious grounds.

S. Irudaya Rajan: While I do agree that the program was managed by women because women have a much higher sterilization rate than men, the decline in fertility is not the end of the story but the beginning of a new era. Most policy makers and journalists think that when you get to a fertility rate of 2.1, population policy is over. Unfortunately, population policy is not the only fertility control policy. We must educate our administrators and policy makers that population policy covers not only fertility but also mortality and migration. These are the three components of population growth. This is the beginning of the work that the government has to do in terms of child nutrition, child mortality and providing jobs for the youth – what we call the demographic dividend. I don’t think this is the time to celebrate the results of NFHS-5.

Many see this decline in TFR as a sign of population stabilization. Is it really so?

S. Irudaya Rajan: I don’t think this is a sign of population stability. For example, Kerala has had almost the same replacement level of fertility for almost 30 years. We have not stagnated; The population is still increasing. The population movement will start now and will probably continue for a few years or even a decade. Only then can we talk about population stabilization. Basically, population momentum means that the population will continue to grow and its growth rate will not be negative. Kerala still has a positive growth rate and we expect a negative growth rate after the 2031 to 2041 census. It will take several decades for India to reach population stabilization. This is the first point.

As I said earlier, the decline in fertility is not going to end India’s human development story. Even when we discuss the low fertility rate, according to statistics, 23 per cent of women get married before the age of 18. The percentage of women aged 15 to 19 who were already mothers/pregnant at the time of the survey was 6.8. However, the adolescent fertility rate for women aged 15 to 19 was 43. This is the beginning of a new era in the population policy of India. It is very important for us to wait and do more than what we have done so that we can have healthy women, healthy children and a healthy society.

At this juncture, does India need drastic measures like the Population Control Act or the two-child norm proposed by Uttar Pradesh and Assam? Do you think the country should move away from coercive measures for population control, taking into account the lessons learned from China’s one child policy, which was abolished a few years ago?

Poonam Mutreja: If the news at the NFHS is anything to go by, it is blowing wind from those who are saying that India needs population control measures. India not only needs to move away from the coercive measures it has in place, but also not think about population control measures. Explain to me why First, Kerala, Tamil Nadu and other states which have has achieved a TFR of [have done so] without coercion. Second, we are going to strike a balance in India because migrants from Bihar and UP are already moving to the southern parts. The country will balance its population even when we reach minus growth rate. Let there be a secular collapse, which is already happening. In fact, 70% of the population is going to be affected by population speed because we have a very young population. We need to provide three or four things keeping them in mind. Our population policy needs to get more vacancy methods, which are long lasting. If you look at people’s access to family planning, a large percentage depends on where you live, your assets, and your age. Younger girls have the least access to family planning services and, therefore, higher teen pregnancies. We not only need to raise the age of marriage but also keep girls in schools and universities for their empowerment and development. If we keep focusing on the force, then we will not be able to focus on the right things. We’re talking barely aging. Those talking of coercive policies in UP and Assam have not thought of aging and improving health systems. If we use coercive methods and use the population to create more disharmony, if we victimize or humiliate a particular population, we must remember the emergency and the effect that forced sterilization has. makes an impact. The biggest lesson from this is that we should not talk about population control or population forcefully.

S. Irudaya Rajan: We should not do politics with fertility. We must talk about the quality of family planning services, which is pathetic. The family planning program has been about following women. They have their first child, then the second. In between she probably had an abortion because there was no method [of contraception], And then sterilization. We must change this and promote temporary methods [of contraception] between men and women. We need innovations in family planning programmes.

What do you think about encouragement and encouragement in family planning?

Poonam Mutreja: There is no evidence to show that linking incentives and incentives for family planning and social planning works globally. In India, we invest so much money in incentives for sterilization. This is part of the problem with why women are not able to have as many children as they want. She has more children than she wants and undergoes multiple abortions, which has an impact on her health. Abortion-related mortality is close to 8%.

S. Irudaya Rajan: I am against giving incentives. I think people are used to having a family with two kids. We should think of new ideas to promote the quality of family planning services. Historically, if you look at India’s family planning programme, we started with the ‘cafeteria approach’ where you can ask what they have and choose. Now, you will be told that there is only sterilization and not many other methods are being promoted. Many couples are using abortion as a form of contraception. This indicates that we have failed to promote temporary methods.

Contraceptive use has improved according to the latest NFHS, but vasectomy is still low. What are the implications of continued emphasis on women regarding family planning?

Poonam Mutreja: NFHS-5 once again proves that women are taking more responsibility and men less. How do we change men? There are myths about adopting contraception. I don’t think coercion is needed, but we need more dialogue on behavior change. We have to change societal norms, especially among the younger population, but we don’t even have sex education. Most of our population movement is going to come from the youth. We must acknowledge that excessive use of female sterilization is adversely affecting the health of women.

S. Irudaya Rajan: We also have to start educating women because some don’t want their husbands to be sterilized. Family planning should be converted into family welfare. A family consists of men and women. We must recognize this in our data collection. I think we have to do more research on women and men. We should turn it into a family affair. Maybe only then we will be successful.

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So, if there is no population control, what should be the focus areas?

Poonam Mutreja: I think a minority community is being targeted, which is the reason to pursue population control. As Professor Rajan said, we should not do population politics. Given that there is a strong preference for sons and aversion to daughters in India, our sex ratio will become more skewed. I do not believe that the overall population will decline that fast. It will just distract us from all the good things we are talking about doing like expanding the likes and social indicators like age at marriage.

S. Irudaya Rajan: There are two important components. One, what we are celebrating is that people in India are living longer. Now, there is a celebration of living longer because it gives you the Human Development Index. But we are only adding years to the masses, not a better quality of life for our senior citizens. Second, migration is going to play a major role in India. I estimate that right now, 60 crore people are internal migrants. But we have no policy on migration. We must look at population policy beyond fertility. We must include the decline in mortality, the quality of life in old age and formulate a migration policy.

What is the way forward in terms of population control, family planning and men taking more responsibility for sterilization?

Poonam Mutreja: The family planning budget is only 6% of the health budget. Within that, we spend 2.5% on temporary methods of contraception. The money spent on incentives is 60% of the budget. Instead it can be used to bring about behavioral change. We have to accept that India will continue to grow because of its young population. And they don’t need family planning, they need access to contraception.

S Irudaya Rajan is the President of the International Institute of Migration and Development; Poonam Muttreja is the Executive Director of Population Foundation of India