15 February 2011

Whither Population Policies in India?

 { This article was published earlier in Economic Times }

K. Srinivasan

     Based on the 2001 census data and earlier trends in fertility and mortality rates the Registrar General of India has projected the population of the country in 2011 to be around 1193 million. The United Nations Population Division, which has consistently projected higher figures for India has estimated for the same year at 1230 million. The UN assumes that there has been a systematic undercount in our censuses which have to be corrected and hence it’s higher estimates. The 2011 census to take place in the next few months will clarify whether we are closer to the UN or GOI projections. Whatever it is we have added about 165 million in the past decade, more than the combined population of six developed countries put together: Australia, Canada, Netherlands, New Zealand, Sweden and United Kingdom without any where matching their resources of land, water and energy. Major portion of this addition of 165 million in the past decade had occurred in the less developed Indian states of the north and among the poorer sections pushing them into further poverty. High population growth continues to be a major factor retarding development in India.

However, India is the first country to launch an official national programme of family planning, as a part of its first five-year development plan (1951-56), with the objective of “reducing its birth rate to levels commensurate with its developmental aspirations”. Its strategy of implementation changed over the years, starting with the “clinic approach” during 1951-1961, “ extension education approach” during 1962-69, “HITTS approach” ( health system based incentive driven time- bound target –oriented schemes) which was largely camp approach to conduct vasectomies during 1969-75, and the “coercive approach” during 1975-77 implemented during the national emergency. Vasectomy, male sterilization, was the main contraceptive method, promoted during the 25 years up to 1977. About 20 million vasectomies were done in India during this period, highest number of sterilizations in the world.

Post emergency, in 1977, the family planning programme suffered a serious setback and vasectomy was considered as a symbol of state despotism and authoritarianism. The number of vasectomy acceptors declined sharply and the contraceptive needs of the people were largely met through the female sterilization. The “Recoil and Recovery phase” of the programme during 1977- 82 was slow but steady with a rising trend of tubectomy operations indicating the felt demand for limitation of family size by the married women. The targets set for acceptors were lower and the population goal was shifted to net reproduction rate of 1 (or replacement level of fertility of TFR of 2.1) setting goals for simultaneous reductions in infant and child mortality levels along with fertility levels. The goals for the crude birth rate or the total fertility rate set in various five year plans were hardly met. The programmed was picking up slowly and steadily during this phase until 1995

Then came in 1994 the recommendations of the International Conference on Population and development (ICPD) held at Cairo, convened by the United Nations, and this conference was dominated by women’s groups and human rights activists who held the view that national programme of family planning should not be an instrument used by the state to achieve any pre set fertility goals since the burden of achieving these goals fell disproportionately on women suffering the consequences of sterilizations and use of various chemical contraceptives, The Programme of Action adopted in Cairo for which India is a signatory, postulated that population policies should be viewed as an integral part of programmes for women’s development, women’s rights, women’s reproductive health, poverty alleviation and sustainable development. They argued that, henceforth, population policies should not be viewed with the sole concern of reductions in fertility rates considered desirable by planners and demographers, but by considerations of reproductive health, reproductive rights and gender equity. So many clichés emerged: such as programmes which are not engendered are endangered. Family planning services have to be provided as part of a number of reproductive health services, listing 13 of them.

The RCH approach came to the dominant approach in India since 1995 abolishing all family planning acceptor targets, the target –free approach (TFA) and the contraceptive services provided based on the Community Needs Assessment Approach( CNA) . The TFA- CNN method is the dominant approach prevailing at present in many states. Integration of various services at the grass root level was the sine-qua-non of the programme.

The policies overarching the implementation of family welfare programmes since 2000 are three: the National Population Policy-2000(NPP), the National Health Policy formulated in 2002 ( NHP) and the National Rural Health Mission launched in 2005 (NRHM). In all these programmes, decentralization, integration and convergence of services are the buzz words going around all the health and family planning programmes in the country. District level RCH societies have been constituted in almost all the districts and central funds for the health and RCH programmes are directly routed through these societies. There has been considerable increase in the resources ploughed into the health and family welfare programmes since 1995, especially after 2005 with the introduction of NRHM and spent through these societies.

A recent evaluation of the approaches adopted before and after the RCH strategy using data collected in the National Family Health Surveys 1, 2 and 3 conducted during 1992-92, 1998-99 and 2005-06 revealed, that the pace of annual progress after 1998 during the RCH phase of the programme, in 24 out 29 indicators of reproductive and child health ( such as child immunizations) is slower than in the pre-RCH phase. If adjusted for higher expenditures incurred in the RCH programmes after 1998, these differences become sharper. Similarly there appears to be enormous wastage in the condoms distributed by government sources (over 50%) as free supplies, falsely over-reporting the users and condoms used in the free distribution system. Decentralization and integration may be good political slogans but they do not appear to be effective in public health and population stabilization programmes. There is a need to revisit our population policy of 2000 and work out different sets of goals and strategies; otherwise population concerns will continue to haunt us for the next few decades.

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