This volcano need not erupt

The Hindu, Sunday Magazine, July 26, 2009

THE OTHER HALF


An open letter to the Union Minister for Health…


Dear Mr. Azad,

After your intriguing remarks on limiting the growth of India’s population, many people must have written to you. Some, including members of my tribe, have poked fun at you, especially in your belief that late night television is an effective contraceptive. Many are not so amused. In fact, some people are more than a little upset. They wonder whether you are being misled, or misinformed, or whether you really want to turn the clock back.

In an interview to an English newspaper, you are quoted as saying that “India is sitting on a volatile volcano”. Volcanoes, when they are volatile, generally explode. So I presume you meant the same thing as those, in the distant 1970s, who spoke of a “population bomb” or of “population explosion”. In July 2003, even our honourable Supreme Court, while upholding the Haryana Government’s decision to impose a two-child norm on all Panchayati Raj elected officials, mentioned the “torrential increase in population”. The thrust of all these different turns of phrase is precisely the same: that Indians are producing children at an uncontrolled rate and that this must be stopped at all costs.

Wrong reasoning

The reasoning behind wanting to stop this “torrent” or “explosion” also remains much the same. In your words, “When population increases, land area decreases. Each development programme means further reduction of land, causing further shortage of food. Large population means greater number of have-nots which is the root cause of poverty, unemployment and law and order. That’s how Naxalism came up.”

You seem to have spent time reading the works of Thomas Robert Malthus (1766-1834) whose most famous premise was: “The power of population is indefinitely greater than the power in the earth to produce subsistence for man.” Malthus has been proved wrong yet new crops of Malthusians keep emerging.

What is surprising about your recent statements on population is that they seem to reflect a total absence of knowledge about the discussions conducted over the last two decades worldwide about the close relationship between population and development. Concepts such as “population control” have long been replaced by “family welfare” and now “reproductive health and rights” even in India. This is not a question of politically correct terminology. The change in the words reflects the growing evidence that population growth decreases as the economic and social status of people, and especially women, improves. This has been more than evident in the countries from where Mr. Malthus originates. And even in a poor country like ours, this trend is evident.

Latest trends

I would draw your attention to data from the latest National Family Health Survey (2005-06). According to it, India’s total fertility rate (TFR) is now down to 2.7 as compared to 3.4 in 1993 when the first NFHS was conducted. In other words, an average Indian woman is likely to produce the equivalent of 2.7 children (we know, of course, that this is just a mathematical calculation and that no woman would produce 2.7 children).

More telling than that is the fact that in no less than nine States, namely Maharashtra, Kerala, Tamil Nadu, Karnataka, Goa, Andhra Pradesh, Himachal Pradesh, Delhi and Punjab — the TFR is now between 2.1 and 1.8, or what is termed the replacement rate. The decline has been steady in all these States, as also in others, but is more marked in the States that also have better indicators for women’s education and social status.

Even in a State like Uttar Pradesh, the TFR has declined, from 4.82 in 1993 to 3.8 in 2005-06. In Bihar, unfortunately, it has gone up — from 3.49 in 2000 to 4.0 in 2005-06. Both States, as you well know, also lag far behind other States in economic and social development.

In 1994, as you surely know, India was one of 179 countries to endorse a Programme for Action at the United Nations Conference on Population and Development (ICPD) in Cairo, Egypt, that upheld the concept of women’s rights as an essential part of any programme on population. It specifically advised against coercive policies that deprive women of choice and their human rights. As a result of this, India dropped its policy of punitive disincentives to push its population policy.

Discriminatory

Yet, we know some States continue to use disincentives, such as the two-child norm for all elected officials in Panchayati Raj institutions. Apart from Haryana, Andhra Pradesh, Madhya Pradesh, Rajasthan, Chhatisgarh and Orissa have adopted similar policies. Only Andhra Pradesh, amongst these, falls within the group of States that have reached replacement rates. Therefore, such policies are clearly not effective and on the contrary end up penalising women officials and encouraging sex selection and sex-selective abortions. If you were permitted to have only two children, most Indians would prefer two boys, or at most one boy and one girl.

In that regard, one must compliment you. In the same interview quoted above, you did say, “We have to drill into people’s mind that a child is a child, no matter if it’s a boy or a girl.” Well said, Mr. Minister.

But such good sense will get negated if the imagery of volcanoes exploding catches on in the context of population. Before long, policies to justify controlling women’s fertility could once again find a place under another guise. Meantime the reality that what matters is whether children survive after birth and whether mothers come out alive during and after their pregnancy will remain unaddressed.

Before there is any temptation to change direction, do spend some time talking to women who are, after all, central to any policy for checking population growth. What do they want? According to the NFHS, there is a 13 per cent unmet need for contraception. In other words, women who would like advice, contraceptives, health interventions, are not getting it. This is where your ministry needs to focus.

If you speak to women, you will also realise that their concerns are basic. India’s maternal mortality rate is 301 for 100,000 live births. These women who do not survive childbirth are malnourished, and die from excess bleeding and the absence of basic healthcare. In a State like Bihar, the figure goes up to 371. And even if the mother survives, there is no guarantee that her child will. Too many children are dying soon after they are born. Do something about this, about access to quality healthcare for the most vulnerable — and you will not need to think of volatile volcanoes and torrents.

Sincerely,

Kalpana Sharma