Family Planning in Asia and the Pacific - International Council on ...

TableTable12 Conditions foster<strong>in</strong>g fertility decl<strong>in</strong>e <strong>in</strong> 15 major states <strong>in</strong> India, 2003-2005Female education(Percentage of marriedwomen <strong>in</strong> reproductiveages with at least primary-level education)High55 or moreInfant mortality rate(Infant deaths per 1,000 births)Medium35 to 54Low15 to 34LowLess than 45 per centMedium45 to 59 per centHigh60 percent or moreBihar (3.80)Uttar Pradesh (3.80)Rajasthan (3.21)Madhya Pradesh (3.10)Assam (2.42) Haryana (2.69)Orissa (2.37) Gujarat (2.42)West Bengal (2.27)Karnataka (2.07)Andhra(1.79)PradeshSource: NFHS-3 (IIPS, 2007).Note: Total fertility rate for each state is shown <strong>in</strong> paren<strong>the</strong>ses.Maharashtra (2.11) Kerala (1.93)Punjab (1.99) Tamil Nadu (1.80)urban. The rise <strong>in</strong> contraceptive use <strong>and</strong> <strong>the</strong> pace of fertilitydecl<strong>in</strong>e, however, has not been uniform throughout <strong>the</strong>country. Progress at <strong>the</strong> national level masks importantdifferentials among subgroups of <strong>the</strong> population14. Forexample, <strong>the</strong> gap <strong>in</strong> contraceptive use <strong>and</strong> fertility between<strong>the</strong> sou<strong>the</strong>rn <strong>and</strong> <strong>the</strong> nor<strong>the</strong>rn states observed <strong>in</strong> <strong>the</strong>1970s cont<strong>in</strong>ues to exist. Without <strong>the</strong> family plann<strong>in</strong>gprogramme, <strong>the</strong> gap <strong>in</strong> contraceptive use between nor<strong>the</strong>rn<strong>and</strong> sou<strong>the</strong>rn states would have been wider. The data showthat contraceptive use <strong>in</strong> <strong>the</strong> nor<strong>the</strong>rn states has <strong>in</strong>creasedover <strong>the</strong> past three decades, <strong>and</strong> <strong>the</strong> current level is higherthan what would have been expected on <strong>the</strong> basis of <strong>the</strong>stronger son preference. However, <strong>the</strong> gap <strong>in</strong> contraceptiveuse between nor<strong>the</strong>rn <strong>and</strong> sou<strong>the</strong>rn states would have beennarrower if nor<strong>the</strong>rn states had a similar social sett<strong>in</strong>g assou<strong>the</strong>rn states.The national fertility average <strong>in</strong> <strong>the</strong> future will dependupon what happens <strong>in</strong> four states, namely Bihar, MadhyaPradesh, Rajasthan <strong>and</strong> Uttar Pradesh, which, accord<strong>in</strong>g to<strong>the</strong> 2001 census, comprised a population of 366 million orabout 36 per cent of India’s total population 14 . Fertility hasdecl<strong>in</strong>ed <strong>in</strong> all <strong>the</strong>se states; TFR, however, rema<strong>in</strong>s highat around 3.1 <strong>in</strong> Madhya Pradesh, 3.2 Rajasthan <strong>and</strong> 3.8<strong>in</strong> Bihar <strong>and</strong> Uttar Pradesh. What happens <strong>in</strong> <strong>the</strong>se fourstates will determ<strong>in</strong>e what happens to <strong>the</strong> national averages.For example, trends <strong>in</strong> fertility decl<strong>in</strong>e <strong>in</strong> <strong>the</strong>se four stateswill have an impact on <strong>the</strong> pace of fertility decl<strong>in</strong>e at <strong>the</strong>national level, <strong>and</strong> improvements <strong>in</strong> female education <strong>and</strong>reductions <strong>in</strong> <strong>in</strong>fant <strong>and</strong> child mortality will <strong>in</strong>fluencewhen India will achieve Millennium Development Goals2 <strong>and</strong> 4 15 .A considerable unmet need for contraception exists<strong>in</strong> <strong>the</strong>se four states <strong>and</strong> wider access to <strong>the</strong> means offertility regulation is required. Fur<strong>the</strong>r streng<strong>the</strong>n<strong>in</strong>g of<strong>the</strong> ongo<strong>in</strong>g family plann<strong>in</strong>g programme will acceleratefertility decl<strong>in</strong>e <strong>in</strong> <strong>the</strong>se states by transform<strong>in</strong>g this unmetneed <strong>in</strong>to actual use, thus reduc<strong>in</strong>g unwanted fertility. Inaddition, <strong>in</strong>creased <strong>in</strong>vestments <strong>in</strong> education <strong>and</strong> health<strong>in</strong> <strong>the</strong>se states will accelerate fertility decl<strong>in</strong>e by improv<strong>in</strong>gwomen’s ability to regulate <strong>the</strong>ir own fertility.In sum, progress made <strong>in</strong> improv<strong>in</strong>g social development<strong>in</strong> addition to <strong>the</strong> progress made <strong>in</strong> streng<strong>the</strong>n<strong>in</strong>g <strong>the</strong>ongo<strong>in</strong>g family plann<strong>in</strong>g programme, especially <strong>in</strong> <strong>the</strong>previously mentioned four large nor<strong>the</strong>rn states, will notonly reduce fertility <strong>in</strong> <strong>the</strong>se states, it will also contributeto <strong>the</strong> future pace of fertility decl<strong>in</strong>e at <strong>the</strong> national level.This is a w<strong>in</strong>n<strong>in</strong>g comb<strong>in</strong>ation because of <strong>the</strong> mutuallyre<strong>in</strong>forc<strong>in</strong>g effects of <strong>in</strong>vestments <strong>in</strong> education, health<strong>and</strong> family plann<strong>in</strong>g programmes on reduc<strong>in</strong>g fertility aswell as achiev<strong>in</strong>g Millennium Development Goals 2 <strong>and</strong>4. The same, perhaps, can also be said about many o<strong>the</strong>rdevelop<strong>in</strong>g countries, especially <strong>in</strong> sub-Saharan Africa,that have high fertility, a poor social sett<strong>in</strong>g <strong>and</strong> weakfamily plann<strong>in</strong>g programmes.149