While the Census, which has a wide coverage, is generally regarded as the official marker of demographic trends in the country, the National Family Health Survey (NFHS) is a pointer to the future. The results of the NFHS-5 are out, and as we celebrate the fact that the Total Fertility Rate (TFR) has fallen to below-replacement fertility levels in the country, signalling the beginning of a demographic transition, it is also important to pay attention to the disparities among States. For instance, Bihar (3.0), Uttar Pradesh (2.4) and Jharkhand (2.3) continue to have TFRs that are significantly above replacement levels, even as most of the other States in India now have a TFR below 2.1.
Across South India, not too long ago, it was common to come across people with first names like Kuppa (garbage) and Penta (dungheap). Such names were deliberately given by desperate parents in the hope that illness and death will not take their child away.
High mortality rates kept the population size artificially low, yet, on average, women had many more children than they do now because they knew that only a few of them would survive till adulthood.
Every State Has its Own Needs
In general, households tend to opt for smaller family sizes when the infant mortality rate declines – part of a complex web of reasons that has driven the demographic transition across large parts of India. The relationship between declining infant mortality rates and increasing female literacy is widely known in demography, and these are two of the primary proximate causes of declining fertility.
However, it is important to note that these are not the only reasons for a fertility decline. Noted demographers, Christophe Guilomoto and S. Irudaya Rajan, argue for a region-specific model, making the case that every State in India has its own trajectories towards a demographic transition.
For instance, while it is certainly true that the demographic transition in States like Kerala has been accompanied by a marked improvement in living conditions, female literacy, and health services such as access to contraceptives, several other states like Andhra Pradesh, Telangana and parts of Tamil Nadu began a demographic transition in the absence of commensurate socio-economic development.
In fact, in States like Telangana and Andhra Pradesh, P. Ramachandran and Ramesh et al. note, “The most rapid decline occurred without any spectacular improvement in the regional level of socio-economic development.”
We Must Make Use of the Window
While the absolute TFR levels remain high, the situation in Bihar, Jharkhand and Uttar Pradesh has improved significantly between the last two rounds of the NFHS. Whether the proximate cause for this decrease in fertility has been an increase in female literacy or not cannot be inferred from the NFHS data just yet, as a closer look at the data can reveal many paradoxes. Overall, it is clear that one size definitely does not fit all, a fact that must be reflected in population-related policies across the country.
So, what are the implications of the decline in TFR in most parts of India?
India continues to have a large number of adolescents and youth. Hence, despite the decline in TFR, it will take some time for overall population growth in the country to slow down.
As per the estimates of the Economic Survey 2018-19, it is expected that the country’s demographic dividend will peak around 2041, when the share of the working-age population (20-59 years) will be approximately 59 per cent. Of course, there will be State-level variations as the demographic transition is happening at a different pace across India.
It is critical that we make the most of this window of opportunity by investing in education, health and skill development for our youth. Enabling access to secondary and higher education as well as suitable opportunities for women to participate in the labour force, needs special focus.
Health, Education & Welfare Services Should be Priorities
Further, with the demographic dividend peaking in 2041, India will begin its transition to an ageing society. Estimates suggest that by 2050, every fifth Indian will be a senior citizen. While national programmes such as the National Programme for Health Care for the Elderly and National Action Plan for Senior Citizens provide a broad policy framework and guidelines, it is imperative that every state formulates and implements a comprehensive plan for delivering health, education and welfare services for the elderly, as well as create meaningful opportunities for their participation in the economy.
In this context, some specific opportunity areas should be explored. For instance, the demand for caregivers is likely to continue rising across India, also due to the rapid pace of urbanisation and the shift towards smaller family sizes. Additionally, with a change in disease patterns and the increasing burden of non-communicable diseases like cancer and cardiovascular ailments, mechanisms for ensuring long-term and continuous monitoring of health status as well as provision of home healthcare services require special attention.
The home healthcare market has already been witnessing accelerated growth over the last few years. This necessitates the development of a robust regulatory framework specifying accreditation standards, licensing requirements, and clinical guidelines for ensuring good quality of care delivered to seniors across India.
(Urvashi Prasad and Adhiraj Parthasarathy are Directors, Development Monitoring & Evaluation Office, NITI Aayog. This is an Opinion article and the views expressed above are the author’s own. The Quint neither endorses nor is responsible for the same.)
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