birth of underweight children
|While the southern States have all achieved admirably low fertility rates, there are problems that persist. Taking stock on the occasion of the World Population Day, observed on July 11…|
July 11 was World Population Day when all defining speeches that originated from New Delhi’s Vigyan Bhavan uniformly chastised the laggard Hindi belt States, while admiring the achievements of the southern States. But, by constantly comparing t he Southern miracle with poorly performing States, crucial challenges which still persist in the South often get overlooked.
The old emphasis on measuring crude birth rates and death rates is passé. For the last couple of decades, demographers have been measuring fertility by the average number of children a woman produces in her lifetime. TFR (Total Fertility Rate) is now the standard benchmark to assess population change. The general feeling is that since the southern States achieved fertility goals set for the country some 10, even 20 years ago, they need only fortify and maintain those achievements. Moreover, lower fertility is widely seen as shorthand for the higher status of women in the South, and more broadly, for superior delivery of public health services. However, while saluting what they have accomplished, let us explore further the most recent National and District Family Health surveys.
Behind the statistics
NFHS-3 and DLHS-3 show that Andhra Pradesh reduced its fertility rate to 2.1 (average number of births per woman) in 2002. Not so long ago, the fertility was at the same level as Maharashtra, a progressive State that, nonetheless, will attain the goal set by the Population policy only this year (2009). So, in comparison, Andhra appears to be a huge success story. But this overlooks the fact that nearly 20 per cent of AP’s girls have started childbearing or are already pregnant by 18. And two thirds of these girls have less than five years of education. AP’s percentage of non-literate girls is two and a half times greater than Maharashtra. In comparison, Himachal Pradesh, which also realised the national TFR goal by 2002, successfully cut child marriages to less than 14 per cent compared to Andhra Pradesh’s prevailing 63 per cent. No wonder then that nearly three quarters of Himachal’s unmarried rural girls have 10-plus schooling. Andhra has a long way to go when judged by this all-important yardstick.
Karnataka presents an analogous picture. The number of early marriages increase exponentially when girls are between 16 and 18, resulting in a fivefold increase in fertility in just three years. An overwhelming majority of these teenage girls have less than five years of schooling or no schooling at all. Such uneducated hands that rock cradles have no chances of ruling the world. Added to that, Karnataka’s maternal mortality is higher than all the other southern States, a truthful mirror of a woman’s place in society and her access to social and economic opportunities.
Things are not all that rosy even in Tamil Nadu, forever cited as a shining example of the successful South. Although the State’s fertility indicators compare with those of Nordic countries like Denmark and Sweden, Tamil Nadu’s maternal mortality is, at the same time, six times higher than the developed world and triples that of Sri Lanka’s. Despite bringing fertility to an all-time low, Tamil Nadu also loses its lustre because 30 per cent of the under-five children in the State are stunted and malnourished. The State ranks below Kerala, Punjab, Jammu and Kashmir and Himachal Pradesh judged by the health of its progeny. Besides having a large percentage of both men and women suffering from severe anaemia, the State also has a poor record of iodine deficiency intake, something that causes miscarriages, retardation, and depleted energy levels in children. Another shocking revelation is that violence against women in Tamil Nadu is very high — comparable to Uttar Pradesh, a State notorious for its parochial attitudes to women.
Coming to Kerala, 20 years ago this exemplary State achieved the TFR set for the country by 2010 — virtually unattainable by the Hindi belt States even by 2030 in the case of ultra-prolific Bihar, Madhya Pradesh and Uttar Pradesh. But in Kerala too, when one looks at childbirths between the ages of 15 and 19, the gradient is very steep. Followed by a cycle of unspaced pregnancies, with heavy emphasis on female sterilization, Kerala’s maternal mortality is twice that of Sri Lanka’s, despite equal levels of education and far higher levels of economic advancement. For a country that is facing double-digit inflation and the aftermath of civil strife, Sri Lanka’s achievements in containing maternal mortality make Kerala’s achievements pale into insignificance.
Areas of concern
The southern States need to place a renewed emphasis on making people understand the need for postponing the age at first birth to ensure that the girl has basic schooling and health when she produces a child. The Union Health Minister wants to award girls who marry only after 25. The links between early marriages, onset of pregnancy and the birth of underweight children need to be viewed holistically. That around a quarter of the children less than five in all the southern States are underweight or malnourished, should have rung alarm bells by now.
Only if children’s health improves can they become a genuine asset for the State and the country. The Southern miracle, were it to be judged by more challenging benchmarks, far from being termed a marvel, may prove to be a myth.