Findings from the fifth National Family Health Survey confirm that India’s total fertility rate (TFR), the average number of children born per woman, has finally dipped below the replacement level of 2.1. Another interesting find is that women could be outnumbering men (1020:1000). But given Census 2011 findings of 940 females per 1,000 males, only fresh Census data may yield a conclusive answer. Also, sex ratio at birth, a key statistic, is still skewed towards boys. Netas who keep flagging the population explosion bogey can instead start focussing on job creation, because the working age population will rise for a while longer before sliding. Only three states – Bihar, UP and Jharkhand – have TFRs over 2.1 now.
Great strides made in educating the girl child may explain the national shift to some extent. ASER surveys suggest that between 2006 and 2018, girls out of school between ages 11-14 fell to 4.1% from 10.3%. Girls aged between 15-16 not enrolled in school dipped to 13.5% from over 20%. Women aged 15-19 pregnant or already mothers declined in this period from 16% to 6.8%. Several indicators point to women gaining autonomy: Nearly 80% have bank accounts from 54% in NFHS-4 (2015-16), 54% have mobile phones against 46% earlier, and 77% used hygienic methods during menstruation against 57% earlier.
But women’s economic situation hasn’t improved. Women who reported working in the past 12 months only marginally rose to 25.4% from 24.6% earlier. Other worries: Health insurance coverage has reached merely 41% of households. Rising figures of anaemic women and children since 2015-16 – 67% of children under 5 and nearly 60% of women under 60 (against the global average of 33% anaemic women in reproductive age) – point to intensifying malnutrition that India’s food security and nutrition supplementation schemes aren’t addressing adequately.
Progress like 88% institutional births against 78% earlier signify that secondary healthcare systems – community and district hospitals – are accessible to more people. A functional public health system obviates out-of-pocket spending on medical needs, which is a major cause of people slipping into poverty. With rising obesity, lifestyle diseases are also vying for attention. Steadily falling TFR also implies an ageing population and greater morbidity burden. In the post-Covid era too, sustain the focus on public health. The larger message is that resources that the state and household need for better and healthier lives will only come if governments.
