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How successful have we been in attaining Population Goals laid down by Policies and Programs – India: A Historical Perspective?

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How successful have we been in attaining population goals laid down by policies and programs? :India:  a historical perspective
Rajna Mishra,Ph.D
Research Scientist, Public Health Foundation of India, New  Delhi

Background, Rationale and Objectives

India accounts for only 2.4% land area and more than 17% of the world’s population.   With  a population of 1.2 billion  i.e., equal to that of six countries, it is anticipated to become the most populous country surpassing China in 2030. 

Fertility decline continues, contraceptive use has increased but quantitative  goals of replacement level fertility is yet to be achieved as a result prospects for country’s future fertility are of considerable interest. This study  aims to

qExamine levels and trends in fertility and family planning indicators at national, EAG & select non EAG states
q:Examine progress achieved under various  policies, programs & schemes 
 

Data and Methods

Data for the study  has been drawn  from various secondary sources – Census, SRS, NFHS, DLHS, AHS & FW statistics.  Geographical coverage included EAG states – UP, Bihar, MP, Rajasthan, Odisha, Jharkhand, Chhattisgarh, Uttarakhand & Assam and Non EAG states of TN & AP that have achieved replacement level fertility

Findings: Levels and Trends

India’s population during 1951 was 361.1 million and increased by more than three times in 60 years to 1210 million in 2011. Although it continues to grow in size, pace of net addition is decreasing due to population momentum and fertility decline. Significant fall in growth rates in Empowered Action Group (EAG) states and non EAG states was seen during 2001-2011.

 CBRwas 21.4 per 1000 live births in 2013.   A decline of about 15 percentage points during the last 40 years period was observed. In EAG states, in 2011 the CBR was as high as 27 per 1000 live births in Uttar Pradesh and Bihar and as low as 18 in Uttarakhand.

 ASFRreveals that highest fertility  attained in the age group 20-24 accounting for about 31 per cent for India as a whole

 TFR during 2012 was 2.4 births per woman. Largest decline   was observed during 2001-2011 (23%) followed by 1981-91 (20 %).  During 2005-2011 after the launch of the NRHM, TFR declined by 0.5 children, a decline of about 17 per cent. India’s TFR was estimated at 5.2 in 1971 and it declined to 2.4 in 2012 (a decline of about 54 per cent in 40 years).  During 2001-11 in UP TFR declined by 24%.

Third and higher order births account for 25 %  of  total births  in India.  The percentage share of higher order births in EAG states vary from 26%  in Odisha to 43% in Bihar and in low fertility states,  it  is about 9% in Andhra Pradesh and 10 % in Tamil Nadu.

 Proximate Determinants: Marriage, Contraception & unmet Need

 Mean age at marriageis  21.2 years for females in India, in all other EAG states it is higher than national average except in Rajasthan (19.8), Jharkhand (20), Bihar (20.1) and Uttar Pradesh (20.2). 

The % of women married before legal age of 18,  in India, is high (22% ) and varies across states. Percentage  of currently married women (20-24 years) married before legal age varies from more than 40% in Bihar, MP, Rajasthan & Jharkhand to around 5% in Tamil Nadu. 

Contraceptive use: CPR any modern method has risen  from 42.5 in 1998-99 ) to 45.7 in 2002-04  and to 47.1 in 2007-08  an annual increase of about 0.5 per cent in nine years.  Recent estimates for EAG states from AHS, 2013-14  reveal that the modern contraceptive use is highest in Rajasthan (62%)  followed by Madhya Pradesh (59%). In Bihar and Jharkhand less than 40 per cent of the currently married women use a modern contraceptive method.  .

Method Mix: Female sterilization is the prime method and accounts for more than 80% of modern method use. Spacing methods account for 10-15%. Overall in  last 20 years a declining trend in male sterilization & IUCD was observed.

Institutional Deliveries a window of opportunity for uptake of Family Planning Services:  JSY scheme resulted in drastic increase in institutional deliveries both nationally (from 56% in 2006-07 to 83% in 2012-13) as well as in all the EAG (more than 80% in states of Bihar, MP, Rajasthan, 50% in UP and in non-EAG states.  Integration of FP & MCH services would help increase uptake of  family planning particularly postpartum contraception

 Unmet Need: 13 per cent of currently married women have an unmet need for contraception ; unmet need for limiting (7%) is slightly higher than unmet need for spacing (6%). Unmet need declined from 20% to 13 %  in 13 years

Findings: Progress under various policies and Programs  

qFirst country in the world to  have an official FP program in 1952 ; Goal: lower CBR from 41 to 20-25 by mid 1970’s CBR -25 attained only in 2002 after 30 years
qNational Population Policy  launched in 1976, FP intensified during emergency period  but complaints of coercion, hence set back in FP in  mid 70s
qAcceptance was made voluntary, uptake declined, 13% modern method use in1970s
qProgram recovered after 1980s, CPR 22%. Number of FP programs implemented through state governments with central assistance
qNational Health Policy (1983): TFR 2.1 by 2000;  TFR – 4.5 (1981), declined to 3.2 (2000) – 29% decline in 19 years but goal remained unachieved
qDuring 90s – shift from vertical to integrated approach, CSSM (1992-97) and continued into RCH ;
q Early 1990s fertility decline occurred, substantial fall in some regions attributable to moderate success of FP program 
qFollowing ICPD, Target Approach was replaced by TFA (1997) and states were required to set targets based on Community Needs Assessment
qNational Population Policy (2000)- immediate objective to address unmet need, medium term objective –TFR 2.1 by 2010
qTFR of  3.2 in 2000 declined to 2.5 in 2010 (decline of about 0.7 children i.e., 22%)
qNRHM – TFR of 2.1 by 2012; TFR in 2005 was 2.9 and declined to 2.5 in 2010 (decline of 0.4 children i.e., about 14%); TFR reached 2.4 by 2012 – yet short of the target
qAs per Twelfth Five Year Plan (2012-17)  goal to achieve  TFR of 2.1

So far goals sets by all policies and programs have not been met

Conclusions and Recommendations

qGrowth rate at current pace will result in doubling of population in 50 years
qDecline in TFR but yet behind the goal, unlikely that replacement level fertility be achieved by 2017 
q Though small family norm widely accepted, existence of huge unmet need especially in EAG states points deficiency in services & depicting principal objective of policy far from being fulfilled
qPredominance of non-reversible methods particularly female sterilization
qMale sterilizations showed a  declining trend nationally & in most EAG states
qInstitutional deliveries on the rise – JSY a window of opportunity for uptake of FP & integration of FP & MCH services
qShifting approach to area specific interventions rather than universalization of schemes/programs in poor performing states
qPromote delaying first  birth
qPromote spacing and post partum contraception
qMotivate men to participate in family planning
qProvide more choices and quality FP services


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