A recent report reveals that 66 per cent of the poorest children in the country receive little or no healthcare. Worse, rural population in the poorest States continue to have more children. Will the Government wake up to the reality?
Statistics, according to many, are damned lies. That is the most comfortable way of dismissing uncomfortable facts. There is, therefore little concern about the recent ‘Save the Children’ report, which tells us that 66 per cent of the poorest children in the country received little or no healthcare. Even our home-grown statistics told us that in 2003 a fifth of the total deaths in the country were of under-five children.
Upbeat as we are about India’s growth, we have no time to check whether things are any better now. Articles about children dying, wasting, stunting and succumbing to disease can be easily dismissed as a failure of Governments and health authorities (which indeed they are).
But what is not understood is how this phenomenon is already reflecting upon development which will ultimately affect every one of us. Poor people continue to have more children to compensate for the ones they lose. In Bihar and Uttar Pradesh, the “wanted” fertility exceed the replacement fertility levels of the National Population Policy. In other words, even if all the facilities in the world are made available, at a certain stage of (under)development, rural people in the poorest States will continue to have more children and this cannot be reduced through conventional approaches.
All States, regardless of age transition, target couples who have two or more children by advocating sterilisation as an end in itself. Hardly any State targets young couples who should not have been married before the legal age of marriage, leave alone be begetting children. The percentage of women and men married before the legal age of marriage in rural areas shows that this is a huge factor.
When the latest National Family Health Survey-III was conducted:
* 12 per cent of women between the age of 15 and 19 were already mothers
* Four per cent of women between the age of 15 and 19 were pregnant with their first child
* In total, 16 per cent women between the age of 15 and 19 had begun childbearing.
Epidemiological evidence as well as common sense tells us that adolescent mothers give birth to underweight children. Low birth weight babies are prone to remain underdeveloped. It is no wonder that 50 per cent of children under five are stunted, 40 per cent are underweight and 23 per cent are wasted. Child mortality is as high as 25 per cent in Uttar Pradesh and Madhya Pradesh.
Behind family planning approaches is the belief that the demand for family planning is high and a substantially proportion of this demand is unmet. What is not understood is that unless there is a certain minimum threshold of social and economic development, families will not adopt the small family norm. State Governments do not think of the implications of the age structure when children are born. The 15 to 19 age group is far from ideal to start procreation, but it is treated as business as usual.
Knowing this entire story, how can sterilisation operations alone make a dent on population stabilisation? By the time sterilisation is undergone, millions of children would have been born and will encounter serious handicaps unable to derive the benefit of a plethora of development schemes. Unless people and particularly parents of girls have an inducement to get them educated, let them acquire skills and become empowered, there will be no incentive to reduce fertility.
Also, if the wanted fertility is not accompanied by commensurate child care (witness the shortfall in immunisation coverage particularly in the northern States), death and disability of children will continue. ‘Save the Children’ resear-chers will have their hands full for the next 20 years.
A resultant phenomenon is the exponential increase in urban population caused by migration. This has already affected mega-cities to breaking point. The slum population of greater Mumbai, Delhi and Kolkata today accounts for more than 55 per cent of the total slum population of the million plus cities in India. This in-migration, although it fills a void in providing urban services, has become a major headache for city infrastructure. Today, the main destination of migration is from Uttar Pradesh into Delhi, Haryana and Maharashtra. Migrants from Bihar largely go to West Bengal followed by Delhi, Haryana and Uttar Pradesh. This leads to polarisation of cultural and political identities and a dangerous growth of regionalism witnessed recently in Mumbai. The net effect of migration will affect population growth in our immediate surroundings. This must be forecast well in advance to deal with the influx before it creates havoc.
Committees, task forces and think tanks will not suffice. It needs an entire Ministry of Population Planning devoted to understanding the implications of population growth and dispersal as a part of overall planning. Unless there is a holistic approach to evaluate the final outcomes of literacy, education, and skill building, supplementary feeding, employment generation to name only a few, departmental silos will continue to judge outcomes by their own standards of achievement. The result will be that the wrong kind of population will get born, will expand and the quality of people’s lives will not improve.
Today, more slums next door are a joy for slum lords and vote-seekers. Tomorrow the children of slum dwellers will rebel against their deprivation and walk into our homes for water and shelter. Numbers will be on their side. The law will have no place.