Moving policy away from population control

India’s focus should be on investment in human capital, on older adults living with dignity, and on healthy population ageing

August 13, 2022 12:15 am | Updated 12:59 am IST

Shoppers at a street in Madurai.

Shoppers at a street in Madurai. | Photo Credit: ASHOK R.

The United Nations’ World Population Prospects (WPP), 2022, forecasts India becoming the most populous country by 2023, surpassing China, with a 140 crore population. This is four times the population India had at the time of Independence in 1947 (34 crore). Now, at the third stage of the demographic transition, and experiencing a slowing growth rate due to constant low mortality and rapidly declining fertility, India has 17.5% of the world’s population. As per the latest WPP, India will reach 150 crore by 2030 and 166 crore by 2050.

A sea change

In its 75-year journey since Independence, the country has seen a sea change in its demographic structure. In the 1960s, India had a population growth rate of over 2%. At the current rate of growth, this is expected to fall to 1% by 2025. However, there is a long way to go for the country to achieve stability in population. This is expected to be achieved no later than 2064 and is projected to be at 170 crore (as mentioned in WPP 2022).

Last year, India reached a significant demographic milestone as, for the first time, its total fertility rate (TFR) slipped to two, below the replacement level fertility (2.1 children per woman), as per the National Family Health Survey. However, even after reaching the replacement level of fertility, the population will continue to grow for three to four decades owing to the population momentum (large cohorts of women in their reproductive age groups). Post-Independence, in the 1950s, India had a TFR of six. Several States have reached a TFR of two except for Bihar, Uttar Pradesh, Jharkhand, Manipur and Meghalaya. All these States face bottlenecks in achieving a low TFR. These include high illiteracy levels, rampant child marriage, high levels of under-five mortality rates, a low workforce participation of women, and low contraceptive usage compared to other States. A majority of women in these States do not have much of an economic or decisive say in their lives. Without ameliorating the status of women in society (quality of life), only lopsided development is achievable .

Demographic dividend

A larger population is perceived to mean greater human capital, higher economic growth and improved standards of living. In the last seven decades, the share of the working age population has grown from 50% to 65%, resulting in a remarkable decline in the dependency ratio (number of children and elderly persons per working age population). As in the WPP 2022, India will have one of the largest workforces globally, i.e., in the next 25 years, one in five working-age group persons will be living in India. This working-age bulge will keep growing till the mid-2050s, and India must make use of it. However, there are several obstacles to harnessing this demographic dividend. India’s labour force is constrained by the absence of women from the workforce; only a fourth of women are employed. The quality of educational attainments is not up to the mark, and the country’s workforce badly lacks the basic skills required for the modernised job market. Having the largest population with one of the world’s lowest employment rates is another enormous hurdle in reaping the ‘demographic dividend’.

Another demographic concern of independent India is the male-dominant sex ratio. In 1951, the country had a sex ratio of 946 females per 1,000 males. After aggressively withstanding the hurdles that stopped the betterment of sex ratios such as a preference for sons and sex-selective abortions, the nation, for the first time, began witnessing a slightly improving sex ratio from 1981. In 2011, the sex ratio was 943 females per 1,000 males; by 2022, it is expected to be approximately 950 females per 1,000 males. It is a shame that one in three girls missing globally due to sex selection (both pre-and post-natal), is from India — 46 million of the total 142 million missing girls. Improvement in sex ratio should be a priority as some communities face severe challenges from a marriage squeeze (an imbalance between the number of men and women available to marry in a specific society) and eventual bride purchase.

Life expectancy at birth, a summary indicator of overall public health achievements, saw a remarkable recovery graph from 32 years in 1947 to 70 years in 2019. It is welcome to see how several mortality indicators have improved in the last seven decades. The infant mortality rate declined from 133 in 1951 (for the big States) to 27 in 2020. The under-five mortality rate fell from 250 to 41, and the maternal mortality ratio dropped from 2,000 in the 1940s to 103 in 2019. Every other woman in the reproductive age group in India is anaemic, and every third child below five is stunted. India stands 101 out of 116 nations in the Global Hunger Index; this is pretty daunting for a country which has one of the most extensive welfare programmes for food security through the Public Distribution System and the Midday Meals Scheme.

Serious health risks

The disease pattern in the country has also seen a tremendous shift in these 75 years: while India was fighting communicable diseases post-Independence, there has been a transition towards non-communicable diseases (NCDs), the cause of more than 62% of total deaths. India is a global disease burden leader as the share of NCDs has almost doubled since the 1990s, which is the primary reason for worry. India is home to over eight crore people with diabetes. Further, more than a quarter of global deaths due to air pollution occur in India alone. With an increasingly ageing population in the grip of rising NCDs, India faces a serious health risk in the decades ahead. In contrast, India’s health-care infrastructure is highly inadequate and inefficient. Additionally, India’s public health financing is low, varying between 1% and 1.5% of GDP, which is among the lowest percentages in the world.

India is called a young nation, with 50% of its population below 25 years of age. But the share of India’s elderly population is now increasing and is expected to be 12% by 2050. After 2050, the elderly population will increase sharply. So, advance investments in the development of a robust social, financial and healthcare support system for old people is the need of the hour. The focus of action should be on extensive investment in human capital, on older adults living with dignity, and on healthy population ageing. We should be prepared with suitable infrastructure, conducive social welfare schemes and massive investment in quality education and health. The focus should not be on population control; we do not have such a severe problem now. Instead, an augmentation of the quality of life should be the priority.

Aditi Chaudhary and Nandlal Mishra are doctoral fellows at the International Institute for Population Sciences (IIPS), Mumbai

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