Demographic transition and demographic imbalance in India

Health Transition Review, Supplement to Volume 6, 1996, 89-99
Demographic transition and demographic
imbalance in India
Ashish Bose
I-1777 C.R. Park, New Delhi
Abstract
In the coming decades, there will be growing demographic disparity in India and, like economic
disparity, this should be a matter of serious concern for our planners and policy–makers. This
demographic disparity leading to demographic imbalance may cause considerable social
turbulence and may even pose a threat to political stability. Demographers must look far beyond
demographic statistics and anticipate the consequences of demographic imbalance between
different regions and states in India as well as between different religious communities, castes and
tribes. Relevant data based on 1991 Census and National Family Health Survey (1992-93) are
presented to highlight the ‘North-South Demographic Divide’.
The world population problem is zeroing in on South Asia and in particular, India, Pakistan
and Bangladesh. India has a special responsibility in this regard because it is the second most
populous country in the world, and is threatening to be the most populous country by the year
2035 or so. India owes to the world a speedy resolution of the population problem by rapidly
curbing the birth and death rates as also the infant mortality rate. The crux of India’s
population problem lies in the states of Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh,
with a total population of 335 million in 1991, accounting for 40 per cent of India’s
population. Our acronym for these states is BIMARU (in Hindi bimaru means sick). In
international literature, the Kerala model of demographic transition has received considerable
attention. The same is not true of Tamil Nadu which is a much larger state than Kerala, in
both area and population. The factors which have contributed to the significant reduction in
the birth rate in Tamil Nadu are different from those operating in Kerala. Leaving aside the
tiny State of Goa, which has the lowest birth rate in India, Kerala and Tamil Nadu are
success stories in the field of population control. As a matter of fact, all the southern states,
Kerala, Tamil Nadu, Andhra Pradesh and Karnataka are doing well in family planning,
whereas the four large states in the North, Uttar Pradesh, Bihar, Madhya Pradesh and
Rajasthan, are lagging far behind. As a result, a peculiar situation has arisen in India in terms
of what we call ‘North-South Demographic Divide’. It is rather unfortunate that India which
claims to be the first country in the world to have formulated a State–sponsored population
control policy is lagging far behind other Asian countries like China, Japan, South Korea,
Taiwan, Singapore, Hong Kong, Thailand and even Muslim Indonesia. Jawaharlal Nehru, the
first Prime Minister of India and the first Chairman of the Planning Commission, knew the
feelings of the people and he very rightly put family planning under the rubric of health, with
the focus on the health of the mother and child. In Nehru’s concept, health included family
planning. It is most unfortunate that under the influence of misguided foreign donor agencies,
there was a paradigm shift in this policy from 1966 onwards and a new Department of Family
Planning was carved out of the Ministry of Health with an elaborate system of ‘targets’,
compensation money and incentives. A large number of foreign experts were involved who

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90 Ashish Bose
relied heavily on contraceptive technology. Even though the money put in by these foreign
donor agencies was not considerable, their effect on ideas was far-reaching. The family
planning program in the 1960s was heavily dominated by foreign ideas and foreign experts.
The system of targets led to widespread falsification of data at the grassroots level and the
system of paying monetary incentives to guest doctors, motivators and clients led to
commercialization of the program which in turn led to widespread corruption. To make
matters worse, the entry of an extra-constitutional authority (Sanjay Gandhi) during the
Emergency led to a perverse family planning program, based on undue governmental pressure
and coercion. The Indian masses hit back during the general elections in 1977 and the
Government of Indira Gandhi was thrown out of power. In the largest State of Uttar Pradesh,
with 85 seats in Parliament, the ruling party (Congress I) could not get a single seat, such was
the fury of the masses. Great damage was done to the family planning program by foreign
ideas and the pressure tactics of Sanjay Gandhi. One may take the charitable view that the
foreign experts as well as Sanjay Gandhi wanted to solve India’s population problem speedily.
Unfortunately, their ignorance of social reality was appalling.
The Registrar General’s latest estimates (1993) of birth and death rates confirm our
diagnosis of India’s population problem in terms of the North-South Divide (see Table 1).
Table 1
Birth and death rates, 1993 (per thousand)
Birth Rate
Death Rate
Natural Growth
Infant
Rate
Mortality Rate
INDIA
28.7
9.3
19.4
74
Kerala
17.4
6.0
11.4
13
Tamil Nadu
19.5
8.2
11.3
56
Andhra Pradesh
24.3
8.6
15.7
64
Karnataka
25.5
8
17.5
67
Bihar
32.0
10.6
21.4
70
Rajasthan
34.0
9.1
24.9
82
Madhya Pradesh
34.9
12.6
22.3
106
Uttar Pradesh
36.2
11.6
24.6
94
Source: Registrar General, India 1995.
It will be seen that the natural growth rate of population is lowest in Tamil Nadu (1.13
per cent) though the birth rate is lowest in Kerala (17.4 per thousand). The growth rate is
highest in Rajasthan (2.49 per cent) though the birth rate is highest in Uttar Pradesh (39.2 per
thousand). The death rate is lowest in Kerala (6 per thousand) and highest in Madhya Pradesh
(12.6 per thousand). So also the infant mortality rate; it is as low as 13 per thousand live
births in Kerala and as high as 106 in Madhya Pradesh; the highest infant mortality rate is in
Orissa, 110 per thousand; 115 in rural Orissa. The tiny state of Goa has the lowest birth rate in
India, 14.7 per thousand, and its death rate is 6.7 per thousand; thus the natural growth rate is
only 0.8 per cent, much below the replacement level of population. The Union Territory of
Chandigarh has the lowest death rate, 2.7 per thousand. Among the states, the death rate in
Nagaland is only 4.7 per thousand followed by Manipur where it is 4.8. Underenumeration in
these remote states and also sampling error may have contributed to the low death rate.
Nevertheless, it is also necessary to study the food habits, physical environment and socio-
cultural factors which contribute to the low death rate in these small states. The three-year
moving average for infant mortality rate for Nagaland is only 7 per thousand for the period
1991-93, as estimated by the Registrar General. The comparable figure for Uttar Pradesh is 73
per thousand.
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Demographic transition and demographic imbalance in India 91
The National Family Health Survey (1992-93) initiated by the Ministry of Health and
Family Welfare and funded by USAID collected useful demographic data through a large-
scale sample survey. The results confirm our analysis of India’s population problem (see
Table 2).
Table 2
Demographic indicators (NFHS, 1992-93)
% of
% of girls,
Birth Rate
Total fertility
% of women
illiterate
attending
(per 1000)
(per woman)
using
females
school (age
contraception
(age 6+)
6-14)
INDIA
56.7
58.9
28.7
3.39
40.6
Bihar
71.4
38.3
32.1
4.0
23.1
Madhya
65.7
54.8
31.6
3.9
36.5
Pradesh
Rajasthan
74.6
40.6
27
3.63
31.8
Uttar Pradesh
68.5
48.2
35.9
4.82
19.8
Kerala
17.6
94.8
19.6
2.0
63.3
Tamil Nadu
43.9
78.7
23.5
2.48
49.8
Andhra
61.5
54.8
24.2
2.59
47.0
Pradesh
Karnataka
53.5
64.4
25.9
2.85
49.1
Source: IIPS 1995.
It will be observed that in the BIMARU states, the total fertility rate (TFR) ranges from
3.6 to 4.8 while in the southern states, it ranges from 2.0 to 2.9. The lowest practice of
contraception is in Uttar Pradesh (19.8 per cent) apart from the small state of Nagaland where
it is only 13 per cent; the highest is in Kerala (63.3 per cent).
The illiteracy rate among females is the lowest in Kerala (17.6 per cent) and the highest
in Rajasthan (74.6 per cent). The southern state of Andhra Pradesh does not fare well when
one considers the percentage of girls in the age group 6-14 years going to school. While the
lowest figure is for Bihar (38.3 per cent), both in Madhya Pradesh and Andhra Pradesh, only
54.8 per cent of the girls go to school, compared to 94.8 per cent in Kerala. In this sense,
Andhra Pradesh is a ‘BIMARU’ state in the South (to use our acronym for a ‘sick’ state).
Interestingly, the TFR in Andhra Pradesh is low (2.6) compared to Madhya Pradesh (3.9). Of
late, Andhra Pradesh has attracted the attention of demographers used to the Kerala and Tamil
Nadu models. What explains the low fertility pattern of this state which is weak in terms of
literacy and education? Is it the impact of films and the large number of cinema halls in this
state? NFHS did not collect data on exposure to cinema but the state reports do contain data
on percentage of married women who have heard a family planning message on the radio or
television and also the percentage of ‘both husband and wife’ who approve family planning.
Table 3 underlines the complexity of demographic analysis:
Table 3
Exposure to family planning messages
Heard FP message
Both husband and wife
on radio/TV
approve of FP
INDIA
42.2
58.4
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92 Ashish Bose
Andhra Pradesh
58.4
77.1
Tamil Nadu
51.9
63.7
Karnataka
66.8
63.2
Kerala
55.9
62.6
Bihar
26.6
46.0
Madhya Pradesh
34.3
50.3
Rajasthan
33.3
59.1
Uttar Pradesh
32.7
42.3
Source: IIPS 1995:178
According to NFHS data, the percentage of both husband and wife approving family
planning is the highest in Andhra Pradesh (higher than in Kerala and Tamil Nadu). This
certainly must have contributed to the comparatively low birth rate of Andhra Pradesh.
Nevertheless, it is necessary to explain why the couples in Andhra Pradesh are so highly
motivated to practise family planning, also why in Haryana, where 79.4 per cent of husbands
and wives approve of family planning, the birth rate is as high as 32.9 and the total fertility
rate 3.99, almost the same as in Bihar.
Apart from qualitative differences in collection of NFHS data, socio-cultural factors
affecting reproductive behaviour need to be examined. The small family norm has crystallized
in Kerala and Tamil Nadu and possibly in Andhra Pradesh also but this is not so in the North
where there is a marked ‘son-preference’ or what we call ‘demographic fundamentalism’,
reflected in the cut-off point of two living sons before family planning is begun.
In the coming decades, there will be growing demographic disparity in India and like
economic disparity, this should be a matter of serious concern for our planners and policy–
makers. This demographic disparity leading to demographic imbalance may cause
considerable social turbulence and may even pose a threat to political stability. Demographers
must look far beyond demographic statistics and anticipate the consequences of such
demographic imbalance between different regions and states in India as well as between
different religious communities, castes and tribes.
A politically explosive situation may arise out of the differential growth rate of
population belonging to different religious communities and caste groups. Table 4 gives the
growth rates of population by different religions communities for the decade 1981-91:
Table 4
Decadal growth rate of different religious communities 1981-91
Religious community
Percentage decadal
Percentage of total
growth rate, 1981-91a
populationb
Buddhists
36.0
0.76
Muslims
32.8
12.12
Sikhs
25.5
1.94
Hindus
22.8
82
Christians
16.9
2.34
Jains
4.4
0.4
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Demographic transition and demographic imbalance in India 93
a Excluding Jammu & Kashmir where the 1991 census was not held and Assam where the 1981 census
was not held.
b Excluding Jammu & Kashmir
Source: Census of 1991, Paper 1 of 1995: Religion.
Interestingly the growth rate of Buddhists is the highest, because of the conversion of
lower–caste Hindus to Buddhism as a protest against social inequity. The high growth rate of
Muslims must be partly attributed to high fertility and partly to migration from Bangladesh
and Pakistan, legal as well as illegal. The Christians have a comparatively low growth rate
because of their low fertility. I am, however, not making a statistical point here but indicating
the implications of different growth rates for the political environment.
With the growth of fundamentalism all over the world and also in India, religion is bound
to be invoked in election campaigns and the agenda of political parties. The different growth
rates of population of Hindus and Muslims is bound to have political repercussions: a
demographic issue may be converted into a political issue. The ramifications of this problem
must be understood. To a large extent, the high growth rate of Muslims is a reflection of their
poverty and illiteracy. The growth rate of the Scheduled Castes population, which is poor, is
also high. The population of Scheduled Castes in India (excluding Assam and Jammu and
Kashmir) during 1981-91 was 31 per cent which is comparable to the figure for Muslims:
32.8 per cent. The Scheduled Tribes also belong to the poorer sections of the population. In
their case, however, the growth rate during 1981-91 was 25.7 per cent which is much lower
than that of the Scheduled Caste population. Obviously, apart from poverty, there are social
and cultural factors which affect the fertility and mortality pattern and the growth rate.
Table 5 gives the decadal growth rate of the Scheduled Caste (SC), Scheduled Tribe (ST)
and non-SC/ST population during 1981-91.
Table 5
Decadal growth rate of population by communities in India a
1981-91 (per cent)
Total population
23.8
Scheduled Caste population
31.0
Scheduled Tribe population
25.7
Non-SC/ST population
22.1
a Excluding Assam and Jammu & Kashmir
Source: Census of India, 1991
It will be seen that both the Scheduled Castes and Scheduled Tribes populations have
grown faster than the non-SC/ST population. These figures must be interpreted in the context
of the growing demand for reservation of jobs for SCs, STs, Muslims and other backward
communities (OBCs). The Constitution of India does safeguard the position of SCs and STs.
There is, however, a growing demand to raise the proportion of jobs reserved for SCs and
STs. Several years back, the Mandal Commission Report on this subject sparked off violent
agitations and led to political instability. It is worth recalling that in the most populous states
of UP and Bihar, the Chief Ministers belong to the weaker sections of the community. This
ushers in a new era of the growing power of political leadership representing the weaker
sections. Since employment opportunities are inadequate, the clamour for jobs has an element
of conflict and violence; religion and caste are invoked to obtain jobs, often without any
consideration for merit. The same is true of the students’ admission policy in institutions of
higher learning, particularly in medical and engineering colleges. This is another conflict
point. Throughout the country, if the masses are asked what is India’s number one problem,
the answer is invariably ‘Creating more jobs’. It is somewhat unfortunate that the family
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94 Ashish Bose
planning program, ever since 1951, has failed to relate population growth to the growth of the
labour force. A high rate of population growth for the last three decades has converted the
population problem into a major unemployment problem. The voting age has been reduced to
18 years, and every person aged 18+, whether employed or not, is a voter. The mere size of
population gives people a tremendous political leverage and the unemployed masses see their
salvation in getting jobs in the government or organized sector.
In 1976, during the Emergency period, a National Population Policy was formulated by
the government. This policy stated that for the purpose of deciding the number of seats in
Parliament and State Assemblies, the 1971 Census population would decide the position of
each state and this would remain so till the year 2001. In other words, the state of Uttar
Pradesh will not have more members in Parliament because its population growth rate was
higher than that of Tamil Nadu. Now there is every possibility that the whole issue will be
reopened in 2001. The Expert Group on Population Policy headed by Dr. M.S. Swaminathan
recommended in its 1994 report that this freeze should continue right up to the year 2011.
A crucial factor which affects family planning is literacy and in particular, female
literacy; here disparities between North and South are very considerable. Within each state
also there is much disparity between the literacy rate of the SC and ST population and the
overall literacy rate. The disparity between the literacy rates of males and females is equally
striking (see Tables 3 and 4).
Table 6
Literacy rate India, 1991 (per cent) (7+ population)
Males
Females
Persons
INDIAa
Total population
64.1
39.3
52.2
Scheduled Castes
49.9
23.8
37.4
Scheduled Tribes
40.7
18.2
29.6
a Excluding Jammu & Kashmir
Source: Census of India, 1991
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Demographic transition and demographic imbalance in India 95
Table 7
Literacy rates, 1991 (per cent)
North
Males
Females
Persons
Uttar Pradesh
Total population
55.7
25.3
41.6
Scheduled Castes
40.8
10.7
26.9
Scheduled Tribes
50.0
19.9
35.7
Bihar
Total population
52.5
22.9
38.5
Scheduled Castes
30.6
7.1
19.5
Scheduled Tribes
38.4
14.8
26.8
Madhya Pradesh
Total population
58.4
28.9
44.2
Scheduled Castes
50.5
18.1
35.1
Scheduled Tribes
32.2
10.7
21.5
Rajasthan
Total population
55.0
20.4
38.6
Scheduled Castes
42.4
8.3
26.3
Scheduled Tribes
33.3
4.4
19.4
South
Andhra Pradesh
Total population
55.1
32.7
44.1
Scheduled Castes
41.9
20.9
31.6
Scheduled Tribes
25.3
8.7
17.2
Karnataka
Total population
67.3
44.3
56.0
Scheduled Castes
49.7
26.0
38.1
Scheduled Tribes
48.0
23.6
36.0
Tamil Nadu
Total population
73.8
51.3
62.7
Scheduled Castes
58.4
34.9
46.7
Scheduled Tribes
35.3
20.2
27.9
Kerala
Total population
93.6
86.1
89.8
Scheduled Castes
85.2
74.3
79.7
Scheduled Tribes
63.4
51.1
57.2
Source: Census of India 1991
With regard to the practice of family planning, the findings of the National Family Health
Survey conducted in 1992-93 are summarized in Table 8.
Table 8
TFR and Practice of FP, 1992-93
TFR (15-49)
Percentage of currently married
women using contraception (any
method)
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Total
Rural
Urban
Total
Rural
Urban
North
Uttar
4.8
5.2
3.6
19.8
16.7
32.0
Pradesh
Bihar
4.0
4.2
3.3
23.1
19.8
42.5
Madhya
3.9
4.1
3.3
36.5
33.4
47.7
Pradesh
Rajasthan
3.6
3.9
2.8
31.8
28.2
47.1
South
Tamil Nadu
2.5
2.5
2.4
49.8
49.2
50.9
Andhra
2.6
2.7
2.4
47.0
43.6
56.6
Pradesh
Karnataka
2.9
3.1
2.4
49.1
47.7
52.0
Kerala
2.0
2.1
1.8
63.3
61.4
68.2
India
3.4
3.7
2.7
40.6
36.9
51.0
Source: IIPS 1995:27-29; 47-49.
In the northern states, total fertility rates are well above the national average while in the
south, they are much below the national average. In Uttar Pradesh the rural TFR is as high as
5.2; the urban TFR is 3.6, while the urban TFR of Kerala is 1.8. What is the effect, if any, of
urbanization, in Uttar Pradesh? Likewise, in the urban areas of UP only 32 per cent practise
family planning compared to Kerala’s urban figure of 68 per cent.
Perhaps literacy gives a clue to the differences between the North and South. In an
environment of literacy such as in Kerala, even the illiterates tend to behave like the literates
(see Table 9).
In Kerala, the practice of family planning is higher among the illiterates than among those
with schooling . Since the family planning program is centred round sterilization, the logistics
and the human settlement pattern in Kerala seem to have contributed to this phenomenon. But
this is not true of any of the northern states.
Disparities between the states are indeed striking. For historical and political reasons, the
reorganization of the states was done on a linguistic basis from 1956 onwards. In the size and
population of the 25 states, India is a picture of demographic anarchy: one state (Uttar
Pradesh) has a population of 119 million while another (Sikkim) has only 406,000. Because of
the growing demand for regional autonomy by tribal communities, there are as many as seven
states in north-east India. The tiny state of Mizoram has the second highest literacy rate in
India, 82.3 per cent; according to NFHS the total fertility rate in Mizoram is 2.3 . In the
neighbouring tribal state of Meghalaya, the TFR is 3.7. No demographic pattern emerges even
in the tribal-dominated states of north-east India.
Table 9
Percentage of currently married women using any contraceptive method by literacy and education
State
Illiterate
Primary School
Middle School
High School
complete
complete
complete
North
U.P.
27.9
28.5
29.5
40.4
Bihar
31.2
42.2
42.4
45.6
M.P
33.6
44.2
42.7
49.1
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Demographic transition and demographic imbalance in India 97
Rajasthan
29.1
42.6
42.9
46.9
South
Tamil
52.4
51.4
52.6
52.3
Nadu
Andhra
43.5
60.1
55.3
52.2
Pradesh
Karnataka
45.5
52.5
52.8
56.9
Kerala
66.7
60.5
60.4
62.9
INDIA
33.9
49.3
50.8
54.6
Source: IIPS 1995:55.
In the small hilly state of Himachal Pradesh in north-west India, because of the difficult
terrain, access to health and education is a problem. Yet in literacy Himachal Pradesh has a
better record than the two most prosperous states of Punjab and Haryana, and the practice of
family planning is better in this state than in the neighbouring states. In fact, Himachal
Pradesh may be regarded as a more successful state than Kerala. It is not industrialization and
urbanization which have made Himachal Pradesh a demographically progressive state, but
the realization of its people that the land cannot sustain them and therefore, salvation lies in
migration. The people also know that without a minimum level of schooling, the chances of
getting jobs are dismal. This has led to higher school enrolment rates, a higher age at marriage
and a higher level of practice of family planning. Since the men migrate, leaving behind their
families in the villages, women have to fend for themselves, look after the land, and cattle,
and also take care of the elderly members of the family as well as the children. The women in
the hills are hardy and self–reliant. Also, successive governments in Himachal Pradesh have
met some of the basic needs of the people like drinking water and electricity even in remote
villages. The combination of ecological factors, fulfilment of basic needs and the initiatives of
the people makes Himachal Pradesh an interesting case for testing the theory of demographic
transition.
The clamour for reservation of jobs for the Scheduled Castes, Scheduled Tribes,other
backward classes (OBCs) as well as for Muslims and other minorities will increase in the
absence of adequate employment opportunities in the organized sector; the vast poverty-based
unorganized sector may increase and unless an attack is made on poverty and the basic needs
of the people are met, no family planning program will succeed. International lobbies are
putting great faith in figures for the ‘unmet demand’ for contraceptives, social marketing,
developing an international market for contraceptives, etc. All this will not work if the literacy
levels in India remain shockingly low and the basic needs of the people remain unfulfilled.
The concern for curbing the birth rate should not be limited to the issue of unmet demand for
contraceptives. What about the unmet demand for safe drinking water which has been an
election promise of all political parties for the last several decades? There is certainly very
great scope for making a quantum jump in India’s mismanaged family planning program.
What we need is a paradigm shift in our perception of the population problem.
Appendix Table 1 presents probable total fertility rates for the year 2001, based on purely
mechanical projections by K. Natarajan of the Office of the Registrar General, India. The role
of the BIMARU states is indeed depressing. The need for a paradigm change in population
policy is, therefore, urgent.
References
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98 Ashish Bose
International Institute of Population Sciences (IIPS). 1995. National Family Health Survey (1992-93):
Summary Report. Bombay.
Natarajan, K.S. 1993. Population projections for India. Office of the Registrar General, New Delhi.
Unpublished Paper.
Registrar General, India. 1995. Sample Registration Bulletin 29,2.
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