Towards a better life for more

VINITA BALI AMIR ULLAH KHAN | Updated on January 12, 2018

Running To catch up   -  Raju V

Tackling fertility rates is the first step to equality, gender empowerment and better workforce participation

Last year, the World Bank reclassified India as a middle-income country. No longer in the lower income bracket, India’s fast-paced growth also made it the fastest growing major economy in the world. However, even as some improvements were seen in maternal mortality and child death rate, India continued to languish on several other indicators such as electricity generation, workforce participation and sanitation.

No access to basic facilities

India is ranked 60th among 79 countries in the just released World Economic Forum’s Inclusive Development Index which is based on three parameters — growth and development, inclusion and inter-generational equity and sustainability. While Lithuania and Azerbaijan occupy the top two slots, China is at 15th position, Nepal 27th, Bangladesh 36th and Pakistan 52nd. Russia and Brazil rank 13th and 30th, respectively.

This is a rude reminder yet again of our persistent paradox. Despite being among the fastest growing economies in the last few years and in the top six in terms of GDP, a vast majority of our people are left behind socially and economically. The contrast between concentration of wealth among a few and the lack of access to the basics of food, shelter, nutrition, healthcare and education among the majority is stark and evident.

Oxfam’s report last week titled An Economy For the 99 Per Cent, and Credit Suisse in its Global Wealth Report 2016 have shown that the richest 1 per cent in India own 58 per cent of its wealth. Moreover, this concentration of wealth has increased — it was 40.3 per cent in 2010. Today, the top 10 per cent of Indians own 80 per cent of its wealth. Rising inequality in a large population has a deep impact on unsustainable migration to cities, lack of access to health and education facilities, and a resultant tension that divides the rich and the poor.

It is critical to acknowledge these facts and orchestrate multiple actions that will address endemic issues in a comprehensive and sustainable manner. An unhealthy, uneducated and unskilled population cannot fulfil the dreams of an ambitious nation wanting to make the twentieth century its own. That is why we need a renewed focus on population control and women’s empowerment through education, workforce participation and reduced fertility rates

Aligned action

Our socio-economic transition requires a concerted effort to bring together various ministries in programmes that are aligned and mutually reinforcing. The ministries of women and child development, social welfare, skill development, human resource development, health and family welfare, and others must coordinate their efforts to develop and execute programmes that enable all people to achieve their potential. The difference in this perspective is that it starts with an overarching outcome and works from there to align the deliverables of each ministry to achieve that outcome.

While we continue to solve the problem of acute poverty, we must focus on its immediate corollary of mounting inequality. Similarly, as we tackle the issue of illiteracy, our goal should be the dissemination of knowledge and skills to produce real GDP growth. Taking care of the sick is important but what we need is universal healthcare that allows equitable and accessible healthcare to all, irrespective of socio-economic and rural-urban differences.

The pressure on the system to support a large population is immense and despite the abundance of natural resources, which we are depleting faster than we are regenerating, our infrastructure is continually stressed by the addition of nearly 22 million people every year. We, therefore, need to prioritise a decline in fertility rates as well. That will help to not only tackle inequalities, but also foster gender empowerment and improved workforce participation to raise productivity, efficiently and effectively.

Women and children

The ₹6,000 promised to pregnant women by the Prime Minister on December 31, 2016, is only a small beginning. Poor reproductive and child health are due to an inter-generational transfer of factors such as anaemia, poor nutrition, and girl child discrimination, combined with poor hygiene and sanitation, and lack of access to adequate food, nutrition and healthcare. These have been insufficiently addressed and are the reason India is rated poorly on most socio-economic indicators. The current ecosystem of 1.3 million anganwadi centres and mid-day meals to 120 million school children must be revitalised to deliver what they were created to deliver. This is low-hanging fruit.

High fertility rates and population increase are a function of poor literacy rates, high prevalence of malnutrition and acute poverty. Population control will work only when all three issues are addressed. The fall in population growth rates that we have seen over the last few decades has been the direct result of increasing education among women.

What needs to be clarified is that if we compare population by wealth quintiles or through levels of household education, the data is similar across communities and groups. The districts where total fertility rate (TFR) is still high are places where there is acute poverty and distress — and where fertility is high among all socio-religious groups.

These are also districts which show the highest incidents of child marriage — leading to early pregnancies and high mortality rates among women and children. Consequently, families tend to produce more children to ensure that a few survive. Additionally, the family planning needs of almost 32 million women are not met today, which means that they continue to have children they do not want, mostly because contraceptive services do not reach them. This also leads to unsafe abortions that are a major hurdle in reducing maternal and infant mortality.

Population growth

India’s population increased from 548 million in 1971 to 1,211 million in 2011. The annual growth rate has declined from 2.22 per cent during the eighties to 1.95 per cent during the nineties and 1.63 per cent during 2001-11 as more girls have gone to school and stayed there. Importantly, the impact of education in lowering fertility can be noted for all groups and for all levels of education, although the impact of primary education emerges as the most significant factor. The category “literate but not having middle school education” reports significant fertility reduction from the category “illiterates”.

The faster decline in TFR is due to a larger segment of the vulnerable populations among the minorities, SCs and STs currently completing the first five years of education. The best results in developmental efforts, therefore, will come with a concerted effort that improves population control and family planning efforts with improved public health and hygiene. Family planning and population control are best achieved when the Government is able to supply good quality education, decent livelihoods and affordable nutrition to its population. We hope the Union Budget will consider these factors when it allocates funds to programmes directed to improving the lives of women and children.

Bali is a strategy advisor and independent director, and Khan a visiting professor at ISB Hyderabad

Published on January 31, 2017

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