The findings of the National Family Health Survey, fifth round, are quite bracing. The most significant one is that the total fertility rate (TFR) for the country as a whole is now below the replacement level of 2.1. Some big states such as Uttar Pradesh and Bihar still have TFRs higher than the replacement level, but these states also show a welcome trend of declining TFRs from the fourth to the fifth round of the survey. This is most welcome. On the plus side, it puts paid to worries about population explosion. At the same time, this sends out the signal that our demographic dividend will not last forever.
The states that attained a TFR of 2.1 or lower earlier have started to see the proportion of the elderly population rise. When the working-age population declines in relation to the non-working population, we have the opposite of the demographic dividend. The wide disparity in TFRs across India gives the country as a whole a staggered, prolonged demographic dividend, without the kind of sharp peak that most nations tend to experience. India must fashion policy to ensure fast growth before the ageing, non-working population becomes large enough to become a drag on growth. Ageing cannot be checked. But how policy helps or hinders growth is entirely in the hands of the people and their representatives, who can make sound policy or fumble, for instance, by squandering state resources on handouts, instead of using them to invest in the physical and social infrastructure that would raise productivity.
The other side of the coin of falling fertility rates is greater agency for women, nearly three-quarters of whom now operate a bank account. Use of contraceptives has gone up. Women’s prenatal care is improving. Vaccination against common childhood diseases reaches three-fourths of the relevant age group. All this is encouraging. At the same time, endemic anaemia among women and children is disconcerting, as is malnutrition among children. It is time political parties focused on improving health as a political priority, as also healthcare.