The Elusive Demographic Dividend

India's failed Family Planning Programme

As a child, I grew with a poster and a slogan that was ubiquitous everywhere. The slogan read “Hum do, Hamaare do”. The picture was of two children – one small boy and another small girl with the caption “Do ya teen bus”.  Loosely translated as “Two or three – no more”. The slogan was about the number of children a family was encouraged to have. Though the slogan talked about three, the poster and the visuals, more important in a country still largely illiterate at the time suggested capping the number at two. Slogans promoting family were everywhere; bus stops, markets, clinics, milk booths … you couldn’t walk a few hundred yards without running into the slogan somewhere.

In the early decades after independence, our political leaders were cognisant of a poor country with limited resources having to feed, house, and educate an ever-growing population. Those were the days before the green revolution, and India was still living from ship to mouth as food production in the country was inadequate. Although the family planning slogans were all over, their success was modest. India was almost entirely back then an agriculture-based economy and, whether one owned land or worked on the lands of others, more children meant more hands to till. There was no mechanisation and, everything from ploughing to harvesting was manual. Not only were more hands needed, the hands needed to be those of boys who would grow up to work the land. So the number of children in a family was usually many, till enough boys were born. Also, as the public health infrastructure was weak, and infant mortality was high, so more children were like an “insurance policy” in case a few died in their infancy. For several decades, the family planning programme continued more or less unchanged.

The more-educated, and arguably more-developed, southern States were more receptive while the north Indian states were largely resistant. In the southern States, governance and health care improved, as did the status of women -driven by the work and legacy of reformers like Periyar, Narayana Guru, and even the progressive Left movement.

There was a bias in all this progress, as later observers would point out. Women were expected to take the lead, and there were a plethora of options available for them – from pills to intrauterine devices.  However, limited mobility and lack of access meant that not too many women would use them. For the men, there were just two options – condoms or vasectomy.  There were few takers for vasectomy as the falsehood was propagated that after vasectomy, a man would become impotent. As for condoms, the government manufactured Nirodh was ubiquitous, though its advertisements were more discreet. However, no data were ever maintained of condom usage – and possibly it was not even feasible to maintain that. The data that was maintained related to the number of condoms distributed.  As the condoms were free or heavily subsidised, those numbers were always high.

All this came to a grinding halt during the Emergency in 1975. Sanjay Gandhi, the young and impetuous son of then Prime Minister Indira Gandhi, found the progress on family planning too slow.  He had devised a five-point programme as a corollary to his mother’s larger 20-point programme, which was expected to be executed by one and all during the Emergency. This had family planning and the two-child norm as a prominent component. Everything in the 5-point programme was fit and worthy – abolishing caste discrimination and the practice of dowry, encouraging family planning, and increasing adult education, as well as tree plantation. The one point in that programme which he pursued with much more vigour was, as far as could be seen, family planning.

Earlier, achievement targets had been handed out to various government departments, particularly the health department. Birth control pills, condoms, and other devices had been made readily available in clinics and dispensaries. To further incentivise people (mostly women) to undergo sterilisation, various household goods like brand-new bucket or utensils had been provided as gifts to those willing to undergo tubectomy.

Sanjay Gandhi, fed up with a decades-old strategy that was obviously not working, chose to speed things up by coercing people into sterilization – as that was and remains a largely irreversible process. He looked at existing targets, found them too low, and revised them upwards. He also ensured that targets were not just issued to health care staff, but to all manner of government servants including teachers and clerks who had little knowledge, understanding, or access to people. The result was absolute mayhem. Old and infirm people were dragged off to have themselves sterilized, as also young couples who in many cases had not even started their families. Men were preferred over women in this case; vasectomies were quicker and faster to perform and the targets could be reached faster.  But women too found themselves going in for a delivery and coming back with a tubectomy and no memory at all of when they had given consent. Through the Emergency, due to censorship and fear, almost everyone kept quiet. But when free elections were announced in 1977, the results signaled not only the end of the Congress Party for a time but also the end of our government’s Family Planning Programme for all time.

Post-Emergency, the Family Planning Programme was rechristened “Family Welfare” in order to remove the odium that had become attached to the term Family Planning. However, birth control initiatives had been dealt a death blow from which the programme has never recovered. Targets were abolished, as were incentives, and slowly the whole programme became just another non-priority activity that the Health department undertook.

That is the point in the above story at which I begin my story, as I started the new millennium working with an organisation called the Population Foundation of India. The organisation was founded, and to some extent funded, by the late JRD Tata along with other many other like-minded industrialists.

The late JRD was the Chairman of the Foundation till his death. He held the unwavering belief during his long life that India’s huge population was a burden and not a blessing. He believed that India’s economic progress, no matter how rapid, would be neutralised by a rapidly-rising population. He put his money to walk the talk and helped set up the foundation of which Ratan Tata continues to be a Board member today. By “my” time, the focus on men in family planning or welfare had nearly disappeared, as had the focus on sterilisations Although no-scalpel vasectomies, painless and non-invasive sterilisation for men, had been devised as also techniques to reverse vasectomies and tubectomies should the need arise, only a tiny fraction of men in the country’s patriarchal society opted voluntarily for vasectomies – and that continues to be the case. Injections like Depo Provera were available for women. Once administered, this is effective in preventing pregnancy for close to six months by making hormonal changes. However, Depo Provera proved controversial, was opposed by many women's groups, and never really took off. The focus shifted entirely to birth control pills.

However, two magical words “Demographic Dividend” killed off the family planning programme completely. Our burgeoning population began to be seen as a boon as India began opening up to the world, in the 1990s, its hitherto closed economy. As consumerism and a consumerist economy flourished, India’s high population began to be viewed as a blessing overnight. India became a huge market for consumer goods, next only to China, and was seen as also potentially the next manufacturing hub for the world. The fact that this huge population was largely young, meant that they were a productive force and, with proper incentives, it was thought that the world could be induced to set up its factories and industries here, generating not just jobs but also revenue.

Today, family planning is a lost cause, despite the fact that large populations can be a blessing only if several things are in place – which they are not in our nation. The best size for any population is one that is coextensive with the size of the economy. Further, the growth rate of the economy should sustain the growth rate of the population. If these conditions are met, then the population level can be regarded as an asset.  With skill development still in its infancy in India and many professionals from India considered unemployable in the world market, we are producing more and more people who cannot support the economy. That is why overpopulation continues leading to demographic disaster for us.

In his address to the nation on Independence Day in 2019, Prime Minister Narendra Modi said that rapid population growth — “population explosion” was the term he used — posed a formidable challenge to our future. In his view, responsible citizens with small families, who contribute to their own welfare and to the good of the nation, should be seen as role models. And parents should think about their capacity to provide for education and healthcare before extending their families. Small families, the exhortation made clear, are in the national interest.  This said, in the years which have gone by since then, no policy initiative has come from the government to lend teeth to this statement.  While the speech was good, no concrete measure as to follow that up meant that vested interests interpreted the speech, on their own terms – i.e. to mean that a small section of the population, in particular, needed to practice birth control, and were not doing so.

Meanwhile, in the Global Hunger Index for 2021 released just weeks ago, India ranks a dismal 101st out of the 116 countries which were measured – behind Bangladesh (76th in the world) and even behind Pakistan (92nd in the world).

There seems to be no political will visible to enforce birth control even-handedly. Till that changes, it is sadly clear that our nation’s future will only get bleaker.

First published by Pippa Rann Books and Media on October 27, 2021