Quality education, health services drive family size in India

Real progress happens in states with high literacy and when people regard fertility a conscious choice that they can control. Reliable methods of contraception must also be widely available.
How India’s populations story plays out depends on its young population.(HT Photo)
How India’s populations story plays out depends on its young population.(HT Photo)
Updated on Oct 17, 2018 11:30 AM IST
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Hindustan Times, New Delhi | BySanchita Sharma

India’s population growth story is far more complicated than its bringing down the total fertility rate (TFR) —the average number of births a woman has in her lifetime – to 2.3.

More than half of India’s population lives in states where the population has stopped growing, with the TFR in urban India and 18 states having fallen below the replacement level of 2.1, which is when the population stops growing.

Yet another one-third of the country’s population has TFR between 2.5 and 3, with the rates being the highest 3.4 in Bihar, which is home to 10% of the population. The country’s demographic transition varies not just widely across regions and states, but also across districts. The states in southern India and a few other regions, including Delhi, have reduced fertility and deaths at a much faster rate than the rest of the country.

According to demographer Ansley Coale, fertility rates begin to fall in a sustained way when people consider fertility a conscious choice that they can control, when they believe that having smaller families is advantageous, and when reliable methods of contraception are widely available. “Family size, whether small or large, is intertwined with reproductive rights, which are tied to many other rights, such as those to health and education, adequate income, the freedom to make choices, and non-discrimination. Where all rights are realised, people tend to thrive. Where they are not, people are not able to realize their potential, and fertility rates tend to be higher or lower than what most people really want,” said the UNFPA State of the World Population Report 2018.


How India grows

How India’s populations story plays out depends on India’s young population.Every fifth person in India is an adolescent (10-19 years) and every third a young person (10-24 years). Every year, 12-14 million people enter the workforce, largely from the northern states.

“India needs to invest in the health, education and technical skill development of this age group to leverage its competitive advantage for economic growth,” said Poonam Muttreja, executive director of the Population Foundation of India.

Rapid fertility decline raises the share of working age population( ages 15-49 years) and leads to a corresponding fall in the dependency ratio. After a few decades, however, this demographic advantage is lost as the share of the elderly population increases.

Low dependency ratio is the period of demographic dividend, which provides a window of opportunity to countries to boost productivity and economic growth. A dependency ratio of less than 67% boosts growth.

India is set to ride this wave, with its dependency ratio falling from 75% in 2001 to 65% in 2011. It is projected to fall to 55% in 2021, where it will remain for two decades before beginning to close at 2041 and finally closing in 2061, when the ageing population will push up the dependency ratio above the critical 67%.

While Kerala and Tamil Nadu, which led the demographic transition in India, are already gaining from their shrunken population, they will lose the dividend before the 1940s when their population ages. In sharp contrast, Jharkhand, Madhya Pradesh, Rajasthan, Uttar Pradesh and Bihar will reach a dependency ratio below 67% only by 2021.

Mind the gap

With the demographic dividend varying so widely between states, India’s challenge is to implement customised and differential policies that correspond with each state’s level of demographic transition.

“Government policies must focus on social and health security and promoting new employment skills for the ageing population in the demographically advanced states of Kerala, Tamil Nadu, Delhi, Andhra, Gujarat, Punjab, Himachal and West Bengal,” said ,” said Shailaja Chandra, former executive director, Population Stabilisation Fund.

“With the population ageing, we need to focus on building skills to provide care, including health and social services, and establish old-age homes and housing models where the older population can live independently with supportive facilities on call,” said Chandra.

In the six states where fertility remains high, promoting sexual and reproductive health services, providing quality education and vocational skills to young people must be prioritised.

“Bangladesh, India, Indonesia, Iran and Turkey all saw substantial declines in infant and child mortality, partly because of wider reach of health-care systems, economic development, reduced poverty, and increased female enrolment in primary and secondary education,” said the UNFPA report. Other factors that led to lower fertility is decreasing infant and child mortality and strong national family planning programmes.


The age of marriage needs to be raised further so young girls are mature enough, physically, mentally and emotionally, to make the right reproductive choices, say experts.

In states with high fertility, contraceptive information and services must reach young people.

“An estimated 70% of the population momentum is fuelled by the young population and young girls don’t want to have kids as soon as they get married. Young couples, especially women, need the information and the tools to choose when and how many children they want,” said Muttreja.

“Young girls have less knowledge and access to contraception and health services and are more likely to succumb to pressure to start a family at a young age, which is not good for the health of both the mother and child,” said Muttreja.

“In the end, our success will not just come in reaching what we imagine is ideal fertility. The real measure of progress is people themselves: especially the well-being of women and girls, their enjoyment of their rights and full equality, and the life choices that they are free to make,” writes Natalia Kanem, executive director, UNFPA.

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