Every ten years, since 1974, the world community religiously assembles to review the status of population growth, its distribution and movement at the global level. Most of us are well aware why there is great concern about the population explosion and its consequences. It is said, Asia accounts for 60% of the total world's population, while India alone contributes about 16%.

It is heartening to note that there is a paradigm shift with regard to population growth and how to bring it down, particularly after the Conference on Population held at Cairo in 1994. Very few people talk about population as a problem in the traditional demographic sense. Population experts are now portraying the population scenario in the broader context of development. They all have called for policy action based on the unmet needs and desires of men, women and families as well. However, despite their attempts and endeavours, the rates of population increase remain quite high in many parts of the globe. This calls for a critical reflection on what might be the best possible approach to the population explosion syndrome that we are experiencing today, particularly in India.

In 1952, India was the first country in the world to launch a national programme, emphasizing family planning to the extent necessary for reducing birth rates "to stabilize the population at a level consistent with the requirement of national economy". After 1952, sharp declines in death rates were however, not accompanied by a similar drop in birth rates. The National Health Policy, 1983 stated that replacement levels of total fertility rate, TFR (the average number of children born to a woman during her lifetime) should be achieved by the year 2000.

On 11 May 2000 India is projected to have 1 billion (100 crore) people, i.e., 16 per cent of the world's population on 2.4 per cent of the globe's land area. If current trends continue, India may overtake China in 2045, to become the most populous country in the world. While global population has increased threefold during this century, from 2 billion to 6 billion, the population of India has increased nearly five times from 238 million (23 crore) to 1 billion in the same period. India's current annual increase in population of 15.5 million is large enough to neutralize efforts to conserve the resource endowment and environment.

The population of India has been estimated at 970.9 million as on 1 July 1998 showing an increase of more than 124.6 million since the last census conducted in 1991(846.3 million). In 1947, when India attained Independence, the population of India was estimated to be around 342 million. As per the estimates of Sample Registration System of the office of the Registrar General of India, the population of India is increasing at a rate of 15.5 million per year. In other words, the last 100 million has been added in less than six years. It may be recalled that before Independence, it took 42 years to add 100 million. Since 1951, when the first Census in independent India was conducted, about 600 million have been added to the population of India. The first 100 million was added in 12.5 years, the second 100 million in 9.3 years, the third 100 million in 6.4 years, the fifth and sixth 100 million in 5.8 years.

It has been estimated by the Technical Working Group on Population Projections appointed by Planning Commission that by 2016 India's population would go up to 1263 million, i.e., by another 31%. While the population of states of Kerala, Orissa and Tamil Nadu will increase by 15% to 19% during 1998-2016, in the states of Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh it would increase by over 40%, the highest anticipated increase being in Uttar Pradesh with 55%. UP's population will cross a mind-boggling figure of 242.8 million by 2016.

The urban population of India has been estimated at 268.8 million as on 1 March 1998. The 1991 census figure was 217.2 million. It has been projected to increase to 425 million in 2016 or an increase of 208 million during a period of 25 years 1991-2016. In other words the urban population would almost double in 25 years. The annual addition to urban population would be around 8.05 million. This would put a severe constraint on infrastructure facilities such as housing, water supply, sanitation and transportation. Around 2/3 of this urban population lived in about 132 class-I cities with a population of 1,00,000 and above in 1991.

In recent years the realization has grown that people are the real wealth of a nation. Progress of a country is measured not only in terms of income expansion and commodity production but also in terms of expansion of human capabilities. Even though countries with higher average income tend to have higher life expectancies, lower infant mortality rates and higher literacy rates, these associations are far from perfect. Inter-country comparisons of income variations tend to explain less than half the variations in life expectancy or infant mortality rate. This does not mean that economic growth is not essential for improving quality of life. How the different segments of the population share the fruits of economic growth are equally important to consider. In particular what the poor get and how much additional resources are used to support public services such as primary health care and basic education are important to consider.

At the time of Independence, expectations of life at birth for the country as a whole was around 32 years. This has increased to 60.3 years during 1991-95. The figures for males and females were 59.7 and 60.9 respectively. The corresponding figures during 1941-51, centred around 1946 were 32.5 and 31.7 years.

At the time of Independence the infant mortality was estimated to be around 180 per 1000 live births. This has decreased by more than half to 74 in 1995.

The percentage of literate population aged 7 and above has increased from 18.3 in 1951 to 52.2 in 1991. The corresponding figures for males and females were 27.2 and 8.9 in 1951 and 64.7 and 39.2 in 1991. According to National Sample Survey Organisation (NSSO) survey 1997, the literacy percentage in the country stands at 62. The NSSO figure show that in the current decade, in a matter of just six years, the decadal average of all earlier years has been surpassed.

Of late "Gender Justice" and "Women Empowerment" have received adequate attention of the governments of developed as well as developing nations. However, the debate on gender development and population planning has received attention only after the United Nation's International Conference on Population held at Cairo in 1994; International Conference on Women held at Beijing in 1995; and Social Summit Conference held at Copenhagen, in 1995. Moreover, UNDP's Human Development Reports 1995 and 1996 have also laid emphasis on Women and development.

The gender issues have emerged due to the fact that while sex is biologically determined the gender and its role specifications are socially, culturally, and traditionally and to some extent religiously constructed. The patriarchal norms dominate society and therefore most women experience "gender oppression" to a greater or lower degree.

The status of women in India is also very low. Out of India's total work force of 314 million, 90 million are women. Figures based on 1991 census and the National Sample Survey Organisation show that 86.5 per cent of women are employed in rural areas. Among rural women workers, 87 per cent of women workers are employed in unorganized sectors like household industries, petty trades and services, building construction, etc. Further a colossal 70 per cent of them are illiterate. Moreover the health status of the majority of women is not sound and they are also not sufficiently involved in the decision making process.

The Government of India is determined to place adequate emphasis on raising the status of women. The Constitution ensures equality and protection to women citizens. Further, article 610A envisages that it is the constitutional duty of every citizen to renounce practices derogatory to the dignity of women. Since the seventies, the objectives of raising the status of women have also been included in different five-year plans. Moreover, the political empowerment of women by making reservation of seats in panchayat raj system; formulation of National Commission on Women and the draft National Policy on Empowerment of Women which seek to provide justice, equal opportunity for power-sharing and decision-making to women at all levels, are significant steps in this direction.

Family Planning Programme in India started way back in 1951 with a clinic-based approach. In the Third Five-Year Plan, Extension Education Programme was adopted with a view to teaching the virtues of a small family. Later came the intra-uterine contraceptive approach was initiated. All these approaches could not show encouraging results. The new approach which started from 1 April 1996 focussing on improving reproductive and child health care facilities and discarding the earlier target-oriented approach, has given a new lease of life to the family planning endeavours.

Women are the major targets of family planning programmes. According to the National Family Health Survey conducted in India the most widely used method of family planning is female sterilization, which is accepted by 67 per cent of current users as against male sterilization of 3 per cent. This signified that family planning programme has largely remained a women-centred programme. Reluctance of men to use permanent methods, frequent fertility, etc., compel women to accept family planning methods. In many cases their feeble health conditions together with the adoption of family planning methods have eroded their health. The lack of quick referral services by the family planning service-providers made women to carry the physical and psychological trauma arising out of sterilization and Intra-uterine Device (IUD) insertion. Further, in some cases they have also to bear the ire of husbands, in-laws and even the society in case of conception arising out of failure of vasectomy. Customarily, women are neglected and also in many cases denied of their own reproductive health rights. The condition of illiterate women belonging to lower castes, classes and religiously orthodox communities and in rural areas is more precarious.

Abortion plays an important role in checking unwanted pregnancies. However, the abortion-related mortality and morbidity in India continue to be high and at least 10 per cent of all maternal death results from abortion. The UNICEF (1990) estimated that roughly five million abortions are performed annually in India and the majority, about 4.5 million are illegal. Notwithstanding the fact that abortion has been legalized in India since 1972 and the country has one of the least restrictive abortion laws, the existence of widespread illegal and unscientific practices is highly disconcerting. In rural areas, due to socio-cultural bindings precondition of conducting medical termination of pregnancy (MTP) against sterilization in government hospitals, exorbitant charges for MTP by private nursing homes and hospitals, etc., compel impoverished rural people to go in for illegal methods. However, stigma of pre-marital pregnancies and hiding of unwanted pregnancies by married women has also promoted illegal and unscientific abortion. The unscientific and traditional methods of abortion such as prolapsy, advising pregnant mothers to consume herbs, pressing foetus and other local practices adopted by charlatans, cause a lot of damage to the maternal health in general and reproductive health in particular. Illegal and unscientific abortions and its related morbidity and mortality are the glorious examples of "gender injustice" or "gender oppression".

Maternal death is defined by the World Health Organisation as the death of a woman while pregnant or within 42 days of the termination of pregnancy, irrespective of the duration and the site of pregnancy, from any cause related to or aggravated by pregnancy or its management but not from accidental or incidental causes.

Maternal Mortality Ratio (MMR) i.e., death per 100,000 live births for the early 1990s, as revealed by UNICEF and WHO data, varies from country to country from a high of 1800 in Sierra Leone to a low of 3 in Greece. India stands at 570 and figures for some rural areas are as high as 1000 or 1200. Further, it is estimated that a woman in India faces a 1 in 37 chance of maternal death during her lifetime.

In patriarchal societies such as India, the low status of women contributes to the invisibility and low public importance of maternal mortality. A maternal death is seen as an individual misfortune rather than an event that deserves public concern. Thus these incidents remains private and invisible.

The low sex-ratio, low literacy rate, low participation in legislative, executive and judiciary process, economic dependence and low nutrition and health status are a few indicators which characterize the low status of women in India. In the UN's Human Development Report 1995 India ranks 99^th on the Gender Related Development Index of 130 nations. The Gender Empowerment Measure which estimates the extent of women's participation in a country's economic and political activities, ranks India 110^th out of 116 nations. The Report has identified three critical areas, i.e., access to education, reproductive health and credit resources, where women face barriers and therefore, urged that as long as these barriers persist, women will not have equal access to opportunities and to the benefits of development.

Indian development planning has always aimed at removing inequalities in the process of development, recognizing the fact that women lag behind due to several socio-economic-cultural-political impediments. The five-year plans have been paying special attention to women's welfare emphasizing female education access to resources and their political empowerment. Women's empowerment received a fresh impetus in the 1980s when women were recognized as a separate target group in the Sixth Five-Year Plan. Efforts, since then, have been directed towards mainstreaming women into the national development process by raising their overall status--social, economic, legal and political--at par with that of men.

The Central Social Welfare Board in cooperation with NGOs has been conducting awareness generation camps for rural and poor women since 1987-88. It aims at generating awareness of their status in the family and society, their social rights, community health and hygiene, technology and environment, etc.

India has taken some laudable steps to correct the maladies afflicting women and the girl child. As a signatory to the World Declaration on the Survival, Protection and Development of Children, the Government of India has drawn up an Action Plan for the Girl Child (1991-2000). In order to highlight the importance of girl child it has taken the help of media and NGOs for a massive campaign. Further, the Government has now regularized the sex determination test to prevent female foeticide by enacting Pre-Natal Diagnostic Techniques (Regulation and Prevention of Misuse) Act, 1994, which came into force from 1 January 1996.

Coming to the arena of education, the Indian State is obliged to provide for free and compulsory education for women and children as laid down in the Constitution of India--Articles 15(3), 45,46. In line with such objectives, Operation Blackboard scheme was launched in 1987 under the National Policy on Education (NPE), 1986. Similarly, in 1989 a national open schooling system was set up to offer a flexible life-oriented programme through distance education. Further, the innovative District Primary Education Programme was initiated based on NPE-1986 and Programme of Action-1992, to achieve universalisation of primary education. To make these programmes effective the Government transferred 'education' to the panchayats by the 73^rd Amendment Act. The mid-day meal scheme, which was introduced in 1995 to popularize primary education, was again underlined in the conference of Chief Ministers held in New Delhi in July 1996.

During the past fifty years the strategy for women's economic uplift has kept changing from time to time based upon the experiences gained. In the 1990s the strategy has shifted to "empowerment of women" and "giving them a voice" from the earlier welfare and developmental approaches. The programme for Development of Women and Children in Rural Areas (DWCRA) launched in 1982-83 has received a boost by the addition of two new components--Community-Based Convergent Services (CBCS) and Information, Education and Communication (IEC). Formation of Thrift and Credit Groups of women for self-help and economic self-reliance has also been encouraged by the Government. A Rashtriya Mahila Kosh was set up in 1993 for extending credit with low transaction costs to poor and needy women. The Indira Mahila Yojana launched in 1995 aims at, inter alia, increasing women's awareness and income through group activities. Another scheme, Mahila Samriddhi Yojana for the uplift of rural women, has been operating from 1 October 1993.

For improving the nutrition and health status of women and children, the Government's initiatives so far are encouraging. As emphasized by the World Bank document, "Improving Women's Health in India", reproductive health is one of the keys to curbing population.

A specific Child Survival and Safe Motherhood (CSSM) programme which was launched in 1992-93 with the financial assistance of World Bank and UNICEF, ensures effective ante-natal care, safe delivery, immunization of mother and infant, control of diarrhoeal diseases and respiratory infections, nutritional education and provision of basic medical care.

In addition, the following specific programmes have been under implementation as 100 per cent centrally sponsored scheme: (i) Universal Immunization Programme (UIP) initiated in 1985 aims at controlling six vaccine preventable diseases-- Neonatal tetanus, Diphtheria, Pertussis (whooping cough), Poliomyelitis, Tuberculosis (child) and Measles; (ii) Oral Rehydration Therapy (ORT) started in 1986-87 aims at preventing deaths due to dehydration among children under 5 years of age; (iii) Prophylaxis schemes against nutritional anaemia among pregnant and lactating mother and against blindness due to vitamin A deficiency among children; (iv) The Acute Respiratory Infections control strategy initiated during 1989 for arresting the rate of deaths due to Pneumonia. Several other schemes such as 'dai' (midwife) training programmes, obstetric care programmes, special check ups for primary school children etc., are being implemented.

In 1997, though, a crucial attitudinal shift occurred; from a contraceptive and sterilization-driven programme to a more sensible reproductive and child health scheme. This took into account management of unwanted pregnancy, promotion of safe motherhood and child survival, prevention and management of reproductive tract and sexually transmitted infections, and reproductive health services for adolescents. This approach advocates education and woman's empowerment as a long-term strategy to stabilize population.

The HIV, AIDS and STD epidemics are nowadays affecting all aspects--economic, social, and cultural--of people's lives. Lack of education and reluctance of clients of use condoms are largely responsible for the spread of these diseases. The World Health Organisation has remarked that women in India suffer double the disease burden than men do from sexually transmitted diseases. The National Family Health Survey has pointed out that in most states a large majority of married women have never heard of STD and AIDS. In addition, women who have heard of AIDS harbour a large number of misconceptions about how the disease is transmitted.

Therefore for safe abortion and safe sex, reproductive health education to women and adolescence education to girls should be given. It is suggested that the medical termination of pregnancy facility by lady doctors and counselling and education on AIDS and STD require to be made available and given at the Primary Health Care Centre level.

The immediate objective of the National Population Policy 2000 is to address the unmet needs for contraception, health care infrastructure, and health personnel, and to provide integrated service delivery for basic reproductive and child health care. The medium term objective is to bring the TFR to replacement levels by 2010, through vigorous implementation of inter-sectoral operational strategies. The long-term objective is to achieve a stable population by 2045, at a level consistent with the requirements of sustainable economic growth, social development, and environmental protection.

In pursuance of these objectives, the following National Socio-Demographic Goals to be achieved in each case by 2010 are formulated:

1. Address the unmet needs for basic reproductive and child health services, supplies and infrastructure.
2. Make school education up to age 14 free and compulsory, and reduce dropouts at primary and secondary school levels to below 20 per cent for both boys and girls.
3. Reduce infant mortality rate to below 30 per 1000 live births.
4. Reduce maternal mortality ratio to below 100 per 100,000 live births.
5. Achieve universal immunization of children against all vaccine preventable diseases.
6. Promote delayed marriage for girls, not earlier than age 18 and preferably after 20 years of age.
7. Achieve 80 per cent institutional deliveries and 100 per cent deliveries by trained persons.
8. Achieve universal access to information/counselling, and services for fertility regulation and contraception with a wide basket of choices.
9. Achieve 100 per cent registration of births, deaths, marriage and pregnancy.
10. Contain the spread of Acquired Immunodeficiency Syndrome (AIDS), and promote greater integration between the management of reproductive tract infections (RTI) and sexually transmitted infections (STI) and the National AIDS Control Organisation.
11. Prevent and control communicable diseases.
12. Integrate Indian Systems of Medicine (ISM) in the provision of reproductive and child health services, and in reaching out to households.
13. Promote vigorously the small family norm to achieve replacement levels of TFR.
14. Bring about convergence in implementation of related social sector programmes so that family welfare becomes a people-centred programme.

It may be the quest for the so-called holistic approach to population containment which is reflected in the list of 14 goals in the new policy or it can be the plain realization that it is an agenda of human development which is focussed on women and children which constitutes the most practical manifestation of a population policy. Of the 14 goals specified in the Policy 2000, one relates to the long-neglected imperative of free and compulsory school education along with that of reducing the school dropout ratio. Few others relate to the area of health and in particular to the need to reduce the infant mortality rate (IMR) and the maternal mortality ratio besides the universalization of immunization of children against all vaccine-preventable diseases.

The key objective of the Policy 2000 is to bring the fertility rate to "replacement" levels by 2010 and the long-term goal will be to achieve a stable population by the year 2045. The Union Cabinet endorsed the policy and accepted a system of incentives for couples adopting the small family norm, opting to do away with disincentives. It remains to be seen if this exercise will achieve the desired results, because, given the illiteracy, unless the people see the disincentives for large families, they may not be inclined to stop with two children. The core of the population problem in the country centres on the higher fertility rate among the poorer sections and the explosion taking place in the less developed States.

The tyranny of numbers is crushing. Despite rapid strides in agriculture, India's food security is tenuous. The ideal diet is 400 kg per person per year, so experts say India needs to produce at least 300 kg per person per year to be free from the hunger trap.

There are other problems. For one, our total annual requirement of fresh water resources is expected to increase to 1,050 cubic km by 2025; aggravated by pollution, the spectre of water famine stares at us.

The 15.5 million additions to the existing population every year requires the opening of 66,000 new primary schools annually, raising foodgrains production from 40 lakh tonnes to 50 lakh tonnes per annum, creating 30 lakh new non-agriculture jobs every year, and accommodating 50 lakh additional labourers in the already crowded agro-sector. That 16 per cent of the world's population lives on two per cent of the land creates its own pressures -- like the loss of 15 per cent of forest cover (an environmental hazard) between 1981 and 1991.

There is no use for a population policy that cannot be easily or effectively implemented. The Central and State Governments must together adopt a cafeteria approach to cater to various needs and segments of the population. It must be left to the health worker and the primary health centre to follow up on couples. Delaying the first child, spacing the second and stopping the third must remain the objective.

1.Persuasive Policy Option for Checking Population Explosion, Dr. M.C. Paul, Yojana: June 1998

2.State of India's Population, 1998; Population Foundation of India, New Delhi

3.Gender Justice, Family Planning and Population Control, B.K. Pattanaik, Yojana: March 1998

4.Safe Motherhood, Khurshid Rehan, Yojana: October 1998

5.National Population Policy 2000, Department of Family Welfare, Ministry of Health & Family Welfare

6.Population Policy 2000, Editorial in The Hindu, 18 February 2000

7.Population Policy: Nostrums Revisited, S. Swaminathan, The Hindu, 15 March 2000

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