The latest National Family Health Survey (NFHS-5), whose findings were released last week, should put a lid on all the politically-charged talk on population explosion in India. The fertility rate in India has been steadily coming down, with the 2019-21 survey putting it at an all-time low of 2 children per woman.
Such a fertility level implies that India may finally have struck a population peak: a rate of 2.1, called replacement-level fertility, is needed for each generation to exactly replace the preceding one.
Uttar Pradesh, which was at the centre of a recent controversy over a proposal to penalize those with more than two children, saw its fertility rate drop to 2.4. Progress is on track, but it’s still one of just five states that fall above the replacement mark.
Here’s a closer look at what has shaped this demographic milestone for India:
1. Urban-rural gap
Rural areas have always had far greater fertility rates than urban areas. But that gap seems to be closing, with even rural India finally reaching the replacement-level mark (2.1) for the first time in the 2019-21 NFHS. Urban India had reached the mark in the 2005-06 survey.
The gap between the fertility rates in the two geographies was 1 point in 1992-93 (3.7 for rural vs 2.7 for urban), which has narrowed down to 0.5 in the last 30 years.
From a fertility rate of 5.4 in 1971, India’s villages have come a long way. India would not have been able to bring its overall fertility rate in check had rural areas not shown improvement, as a majority of Indians still live in villages.
Not just on the total fertility rate, the countryside has shown improvement on related fertility indicators such as adolescent pregnancies and awareness and practice of family planning as well, the data shows.
2. Fertility age
As women marry later, fertility has been declining across younger age groups, even in the 20-24 and 25-29 brackets when women are at their fertility peak, past data from the Sample Registration System has shown. However, the biggest change was noted in the 15-19 age group, with a marked decline in teenage pregnancies over the years. This should be seen with the fact that fewer women now get married before the legal age of marriage at 18.
The mean age of fertility also inched up from 26.5 years in 2011 to 28.4 years in 2018. The trend of marrying late is more common in cities, and this gets reflected in fertility data, too. The median age of marriage was 19.8 in urban areas compared to 18.1 in rural areas, showed NFHS-4 data. This has been accompanied by a rise in fertility in women above 30 years in cities and towns—the major exception to declining fertility trends.
3. Laggard states
Bihar, Meghalaya, Uttar Pradesh, Jharkhand and Manipur remain the only five states with fertility rates above the replacement level and the national average. Each of these states has historically been plagued by relatively higher levels of fertility than the rest of India.
Bihar, which suffers from the highest fertility rate, is among the states that have actually seen the biggest declines in fertility since 2015-16. But since it had a fertility rate of 4.0 in 1992-93 compared to the national average of 2.8, in a way it has improved much more than the rest of India in this period.
However, the trend has not really been steady: fertility actually showed an uptick between 1998-99 and 2005-06. Such lack of consistency is somewhat common in each of these five laggard states.
To reach the last mile and attain population stabilization, such states need sustained investments in the education, health and developmental needs of young people, said Sanghamitra Singh, a health scientist at the Population Foundation of India.
4. Underlying roadblocks
India’s declining fertility is not a consequence of any top-down policy or coercive sanctions, but a sign of increasing prosperity. While it still has a long way to go, the country has progressed on a slew of indicators such as literacy, marriage age and family planning, which directly or indirectly impact fertility. In 2018, the fertility rate was 3.0 among women who could not read, compared to 2.1 among literate women.
The five laggard states underperformed on one or the other contributing indicators as well. Bihar and Jharkhand performed worse on women’s literacy, under-age marriage, economic opportunity for women and the practice of family planning methods. Uttar Pradesh fared poorer on three of these four indicators.
Meghalaya and Manipur performed far better than the national average on the first three indicators, but lagged on the use of contraception.
5. Gender roles
Even in 2021, one in three married women aged 15-49 do not use any method of family planning—even traditional methods such as avoiding sex on days when the pregnancy risk is high. The burden of contraception still largely falls on women, data shows. As many as 38% married women rely on female sterilization to prevent unwanted pregnancy.
Male sterilization is a rarity, and has significantly declined since 2005-06, from 1% to 0.3%. The use of condoms is low at 9.5%, seeing a modest rise from 5.6% in the last five years. Even in urban areas, the use is only moderate. The last NFHS round’s finding, that a large number of men see contraception as a “woman’s business", still rings true.
Ensuring men take responsibility needs targeted social and behaviour change communication strategy, Singh said. “Most programmes operate from the perspective that women are contraceptive users," she said, suggesting that more male health workers be deployed who can be “ambassadors of change to promote family planning uptake among men".
