India has a long way to go before it can stabilise demographic growth, says the second National Family Health Survey. High levels of poverty, hunger, illiteracy, and poor basic health services continue to be the main hurdles for the world's oldest birth control programme. The survey is based on interviews with 90,000 women, between 15 and 49 years of age, from different parts of India and speaking 17 different languages.
Goa, Kerala, Tamil Nadu and Andhra Pradesh have checked their population growth rates considerably. Their success is attributed to high levels of literacy, as women are made more aware of reproductive health issues. But further decline in fertility will be difficult, says TK Roy, director of the Institute for Population Studies, which carried out the survey. The new National Population Policy (NPP) announced earlier this year aims for a national average of two children per couple by the year 2010, compared with the current average of three to four, and zero level growth by 2045. The four large problem states, Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh, have shown little progress in reducing fertility levels and infant and maternal mortality rates. These states together account for 40 percent of India's population.
Contraceptive use by women is up from 41 percent to 48 percent, but most prefer sterilisation, and few use spacing methods like pills and condoms. V. Ramalingaswami, former chief of the Indian Council of Medical Research (ICMR), points to this, early marriage, and the deep-rooted preference for boys, as the major reasons babies are born in quick succession, within two years of each other.
Improved immunisation coverage has resulted in lower infant mortality levels in most states. Still, only 42 percent of babies between 12 and 23 months get all recommended childhood vaccinations. Malnutrition has declined from 52 to 47 percent in the last decade, but the problem continues to be serious, with one in 11 Indian children dying before the age of five. ''This is the highest level of under-nutrition anywhere in the world,'' says Fred Arnold of the U.S.-based 'ORC Macro', which provided technical support for the survey.
Mothers-to-be also lack basic nutritional and health care. Only 20 percent of pregnant women get the minimum needed, three health check-ups during pregnancy, supplementation with iron and folic acid, and tetanus injections, and one in 37 risk dying from pregnancy-related complications, according to WHO and UNICEF estimates. ''Although access to professional delivery care is improving, nearly half of the women have no say regarding their own health care,'' says Sumati Kulkarni, who co-ordinated the survey. Only one in three births takes place at a proper health care centre, and only 40 percent of births are attended to by health professionals.
The Indian government announced the NPP on May 11, the day the country's billionth officially recognised baby was born. Two months later, it set up India's first National Commission on Population, a 100-member committee of experts and political leaders, headed by the prime minister. The number of seats in the Indian parliament has been frozen till 2026. States which have done well in birth control argue they should not have lesser parliamentary representation and a smaller slice in national development funds because of their relatively small numbers. (IPS)