India's total fertility rate has fallen to 2.0 from 2.2, according to the latest nation-wide findings of the National Family Health Survey-5 released by the Ministry of Health. This is below the replacement level of 2.1 which is essential for population stability. The decreasing fertility rate suggests that India's population is now stabilising.
The stabilising fertility rate also busts the population-explosion myth, reads a statement by Population Foundation of India, a national non-profit organisation working in the areas of development and health.
Total fertility rate is the average number of children a woman can give birth to during her lifetime. According to the Organisation for Economic Co-operation and Development (OECD), assuming there are no migration flows and that mortality rates remain unchanged, a total fertility rate of 2.1 children per woman generates broad stability of population. The United Nations also states that countries experiencing fertility rates lower than the replacement level are not producing enough children to replace the current generation.
The data released on Wednesday is for India and fourteen states and union territories. The data of the other 22 states and UTs and was collected before the COVID-19 pandemic struck the country and was released in December 2022. Phase-II was conducted in 2021 and the findings do reflect the impact of the pandemic.
The current survey has shown improved indicators for maternal health, child nutrition, and family planning. It has also shown that the proportion of people suffering from anaemia and obesity have increased in the same period.
Phase-II surveys were conducted in the states of Arunachal Pradesh, Chhattisgarh, Haryana, Jharkhand, Madhya Pradesh, Odisha, Punjab, Rajasthan, Tamil Nadu, Uttar Pradesh, Uttarakhand and UTs of Chandigarh, NCT Delhi, and Puducherry between January 2020 and April 2021.
Fertility Rate Improves
While the nationwide fertility rate has fallen, there are still a few states whose fertility rates are higher than the national average. When compared to the levels in 2015-16, when the fourth round of the NFHS was conducted, except Kerala and Tamil Nadu all the states and union territories have shown a reduction in fertility levels. Both the southern states have a fertility rate of 1.8, an increase from 1.6 and 1.7, respectively
Andaman Nicobar, Goa, Chandigarh, New Delhi, Puducherry, Punjab are few of the states and union territories with low fertility rates. Sikkim with its rate as 1.1 is the lowest. Ladakh has shown the most improvement as its fertility rate dropped to 1.3 from 2.3.
Although Bihar's fertility rate has dropped to 3.0 from its earlier 3.4, it still continues to have the highest fertility rate in the country. Meghalaya (2.9), Manipur (2.2), and Uttar Pradesh (2.4) have a higher fertility rate than the national average.
BOOM spoke to Sanghamitra Singh, Senior Manager, Knowledge Management and Partnerships at Population Foundation of India, to understand the implications of fertility rate falling below replacement levels.
"Fertility rate below replacement rates does not mean that we will see an immediate stabilisation in the population of the country. It will continue to grow for the next two- three decades and then stabilise. It will be growth, not an explosion," Singh explained.
As close to 70 per cent of India's current population is below the age of 35, Singh added that they will have at least two children but that does not mean that India can relax its policy making initiatives. "There are still inter-district and inter-regional disparities. For states like Bihar and UP, interventions have to be designed for adolescents to continue to stay healthy. For other states, it is necessary that the government has policies for geriatric care, older women, women empowerment, and female literacy. "
The decreased fertility rate is also attributed to the surge in uptake of family planning services, the data shows. The unmet need of family planning- when women do not wish to get pregnant but avoid contraception- has fallen by three per cent- from 12.9 to 9.4, thus suggesting that more women are using one of the many family planning methods.
Use of any methods (modern such as contraceptives, IUDs, injectables, condoms, sterilisation as well as abstinence or pull-out) to avoid getting pregnant has increased to 66.7 per cent from the earlier 53 per cent. While condoms account for only 9.5 per cent, the larger onus is on female sterilisation. Female sterilisation accounted for 38.7 per cent of family planning methods. On the other hand, vasectomies- male sterilisation stood at a mere 0.3 per cent.
The dependency on tubectomies- female sterilisation shows that the burden of family planning falls on the woman rather than the man. Highlighting this disparity, Singh added that there was a need for timely social and behavioural change communication to be put in place so that this responsibility is equally shared.
"Male sterilisation is abysmal because of limited engagement of the male with the health workers providing reproductive health care services. Men are not comfortable speaking about sterilisation with the predominantly female health workers. Also, the patriarchal norms make it difficult for them to consider vasectomies. New targeted policies should be designed that help men to understand that their sterilisation is faster, less complicated, and more convenient than those of females, " Singh added.
Singh concluded by saying that an uptake in men using family planning methods will only come about through proper information dissemination.
Other Women And Child Health Indicators Show Improvement
Phase-II results show that there have been timely investments in maternal and child health which have led to improvements in these indicators.
The number of pregnant women attending all four antenatal care visits increased to 58 per cent from the earlier 51. 7. Home deliveries witnessed a fall while institutional deliveries saw a spike. However, the number of births through caesarean section also jumped to 21 per cent from 17.2. This was attributed to a larger proportion of women in the urban areas who chose to deliver through c-section.
For the first time, the sex ratio of females to males at birth is higher in the country. In NFHS-4, this number stood at 991 and it is now at 1020.
In the same period, almost 76.4 per cent children between 12-23 months of age completed their routine immunisation. While the proportion of under-nourished children decreased, the proportion of over-weight children increased.
Anaemia, Obesity Worsens
The survey highlights that Indians continue to struggle with anaemia. Low haemoglobin and iron levels were found in men and women in across all ages. The proportion of anaemic Indians have increased from 2015-16. Similarly, both children and adults have a high body mass index and the number of obese individuals has increased.