Stand up and be counted
Almost as frequent as the predictions of India’s economic momentum is a reference to its demographic dividend. By 2050, predict economists at Goldman Sachs, for instance, India will be one of the world’s four leading economies. By 2050, agree demographers, India will indisputably be the world’s most-populous country, with 1.63 billion people, followed by China with 1.44 billion, and the US a ‘poor’ third with a mere 420 million people. In the new India, this is largely seen as an advantage. Population stabilisation no longer seems a relevant issue, let alone a burning one.
While most developed countries and China show a declining trend in the youth/working population, India’s percentage of people aged 15-59 years is expected to rise from 58 per cent in 2000 to peak at around 65 per cent by 2025, before gradually declining back to 2000 levels. So yesterday’s population ‘problem’ has now become an asset that will drive India’s development engine. Is this really the case?
To contribute to a country’s economy, especially a knowledge economy that India increasingly sees itself as, a person not only has to be young — he or she has also to be healthy and skilled. Today, although India’s population growth rate is declining, because so many people are in the reproductive age group, the actual number of people is growing. Every year, 26 million babies are born. What conditions are these babies born into?
According to Ministry of Health and Family Welfare data, 42 per cent of these babies are born to families that already have two children. Five million are born to teenage mothers — adolescent pregnancies (15-19 years) contribute to 19 per cent of total fertility in India and record the highest maternal mortality rates. According to the Third National Family Health Survey or NFHS-3 (2005-06) 32 per cent of these mothers have had no education, implying low socio-economic status.
Consequently, a large number of these babies are severely malnourished. The NFHS-3 survey of nutritional status of children under the age of three showed that more than a third were stunted or too short for their age, a fifth too thin for their height, and 46 per cent — almost half the country’s children under the age of three — were underweight. Madhya Pradesh, Jharkhand and Bihar have more than 58 per cent underweight children. Further, nationwide only 44 per cent of children aged 12-23 months have received all recommended vaccines. In 2025, these children will be entering the labour force.
Neglect of basic child health has a long-term cost that could offset the benefits of an economic boom. For example, childhood stunting leads to shorter stature as adults, and a 1991 study estimates that one per cent decrease in stature due to nutritional reasons lead to a 1.4 per cent decrease in productivity. Other studies have shown that micronutrient and iron deficiency during childhood leads to a lasting deficit in cognitive ability. Vitamin A deficiency due to malnutrition could lead to blindness. Way back in 1997, according to one calculation, the economic burden of blindness in India for that year was Rs 15,900 crore ($ 4.4 billion), and the cumulative loss over the lifetime of the blind was computed at Rs 2,787 billion ($ 77.4 billion). Childhood blindness accounts for 28.7 per cent of this lifetime loss. The annual cost of treating the country’s 2.7 million polio-affected people was estimated at Rs 3,000 crore in 2004. In addition, there would be man-hours of work lost and hidden opportunity costs.
Apart from health, another reason why the demographic dividend may not be as much of a boon is unequal growth in population. In four key southern states driving India’s economy — Kerala, which is an exporter of skilled labour, and Karnataka, Andhra Pradesh and Tamil Nadu, which are popular investment destinations — the Total Fertility Rate (TFR) today is less than 2.1. TFR means the average of the number of children a woman is expected to have during her child-bearing year and India aims to reach the figure for its national population by 2010.
In contrast, economically less developed states in the north and the east — Uttar Pradesh, Madhya Pradesh, Bihar, Rajasthan, Jharkhand — all have TFRs greater than 3.0. This means that on average families have more than three children, and their baby boom will continue into 2025, even as the populations of the south begin to stabilise and fall. Indeed, in Uttar Pradesh today, almost two-thirds of couples have three or more children.
This sort of population imbalance could end up having political consequences as well. Internal migration, with all its economic and social consequences, is bound to become a major issue. We have already seen, for example, the conflict between nativist political groups and north Indian economic migrants in Mumbai and Maharashtra.
In order to fulfil its economic potential, India cannot focus on just quantity but also quality, population stabilisation remains important as ever, and India can’t pretend it can do or needs to do nothing about it. For instance, 188 million couples need contraceptive cover currently — but only 53 per cent are using some sort of contraception. Meeting that need could mean fewer Indians in the long-run, but healthier, better-educated ones as well. It’s a process that will require several decades, but the work must start now.
(Supriya Bezbaruah writes on health and science)