Ensuring democracy
H.K. DUA, Editor-in-Chief
Reform of Parliament
Subhash C. Kashyap
Parties in disarray
Pratap Bhanu Mehta
Judicial independence
Fali S. Nariman
Responsive governance
N. N. Vohra

Fighting corruption
N. Vittal

Criminalisation of politics
B.G. Verghese
Strategic vision
K. Subrahmanyam
India’s global role
M.K. Rasgotra
Neighbours and friends
S.D. Muni
Economic roadmap
Pranjoy Guha Thakurta
Energy for progress
S. K. Sharma
New agriculture
S. S. Johl
Save the cities
Water use and waste
Ramaswamy R. Iyer
Science in the 21st century
R. A. Mashelkar
Lessons in education
K. N. Pathak
Empowering women
Mrinal Pande
Problem of numbers
Ashish Bose
How to protect environment
Darryl D’Monte
Health of the nation
Usha Rai

No push-button solutions

Ashish BoseAshish Bose

From Malthus to Manmohan Singh (via Marx) is a long march. It is no more politically correct to talk of "population explosion". Instead, one talks of "demographic bonus" and the emergence of India as a world economic power in a matter of decades. What about population stabilisation, a much-cherished goal set out in all Five Year Plans, from the First (1951-56) to the Tenth (2000-2007)?

The National Population Policy 2000 puts the magic figure of 2045 as the goal for population stabilisation. No serious demographer believes that this goal can be achieved, given the poor performance in what I call BIMARU states (Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh) which are responsible for India’s growing demographic burden. The so-called demographic bonus may only land us in a big trap where the unemployed and unemployable youth will seek government jobs in vain and agitate politically for reservation of jobs invoking caste, tribe and religion.

MANAGING THE BOOM: The road to population stability is full of pitfalls
MANAGING THE BOOM: The road to population stability is full of pitfalls

In desperation, they will vote out governments or set fire to public buses to show their anger. It should be clear to the advocates of population control that there are no push-button solutions to the population problem.

The road to population stabilisation is long, arduous and full of pitfalls. It is worth recalling that the 20-Point Programme put forward by Indira Gandhi after imposing Emergency in 1975, did not include population control. However, family planning was included in Sanjay Gandhi’s 4-Point Programme which unfortunately resulted in coercive methods and even body-snatching in the name of fulfilling sterilisation targets. This was totally unacceptable to India’s voters, especially those in the northern states which were under the strong influence of Sanjay Gandhi. This was largely responsible for the exit of the powerful government of Indira Gandhi in 1977 after the general election. India is not China. In 1985, Rajiv Gandhi wanted to restructure the Family Welfare programme. He asked me for a note on the subject. In my note I maintained that the focus of population planning should be squarely on four states: Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh.

My acronym was BIMARU (put in alphabetical order). BIMARU describes aptly the demographic sickness of these states which account for 40 per cent of India’s population, 42 per cent of the growth in absolute numbers and 48 per cent of India’s illiterate population. I called Orissa an Ati-BIMARU (extremely sick) state because of its highest mortality rate. I also pointed out that the much-adored Kerala model was not applicable to these states. Rajiv Gandhi accepted my advice but he soon got engulfed in political turmoil and his tragic death ended the story of restructuring the programme.

It is hard to move forward
STRESS OF NUMBERS: It is hard to move forward

The coalition government of UPA put population issues on the back burner given political exigencies. The Common Minimum Programme (CMP) had blundered in referring to the need for "a sharply targeted population control programme" to be launched in 150 high-fertility districts. ‘Target’ is now a dirty word in political demography and the experts who drafted the CMP realised that their statement was not politically correct. An office memorandum quietly issued by a Director in the Department of Family Welfare on December 10, 2004, modified the words "population control programme" and inserted a clumsy sentence as follows: "The UPA Govt. is committed for population stabilisation programme focusing on high fertility states that learns from the successful experience of southern and other states should be promoted through strengthening comprehensive primary health care." It is wise to move from population control to primary health care. But the tragedy is that there is almost a total collapse of primary health care infrastructure almost all over India. One should not be impressed by statistics on the large number of Community Health Centres (CHCs), Primary Health Centres (PHCs), Sub-Centres (SCs) reported in Health Ministry documents because most of these are not fully functional.

It was therefore in the fitness of things that Prime Minister Manmohan Singh took upon himself the responsibility of launching a new (though it was not so new) National Rural Health Mission (NRHM) on April 12, 2005. He also reconstituted the unwieldy National Commission on Population and at the very first meeting ( July 23, 2005) declared: "I sincerely believe that coercion of any kind to achieve population stabilisation is unacceptable in a free society".

Professional help

Recognise that providing health care to a billion-plus population is a gigantic task which cannot be the sole responsibility of bureaucrats in the Central and State Ministries of Health and Family Welfare. There is no need to appoint more commissions, launch more missions or think of a Task Force for every new problem. Try management solutions, bring in professional people wherever they are available (corporate sector, private doctors and health institutions, NGOs, academic experts, brilliant administrators, retired army officers and even experts from abroad like Sam Pitroda who ushered in the telecom revolution in India). But at the same time, clearly recognise that the Government cannot abdicate its responsibility to deliver primary health care to the people. If they fail in this task, the government, Central or State, must be voted out of power. People have the right to demand health.

Keep politicians out. Those of us who do field work all over India know how angry (and legitimately too) people are with politicians who do not inspire masses any more. Misguided legislation in several states, like disqualifying elected panchayat members if they have more than two children are bound to be counterproductive. Politicians, right from Parliament to panchayats, are not role models any more; only film personalities appeal to our young men and women. Remove all legislation trying to coerce people to adopt a small family norm from the statute books.

On the whole, Indian masses have very rightly not looked to religious leaders about family planning, though conservative Muslims have been greatly influenced by the misinterpretation of religious edicts by certain mullahs, as several Muslim scholars have pointed out. Bringing in religious leaders will only complicate matters. In short, we must keep out politicians and religious leaders from the family planning programme. And also keep out the police and coercive measures in family planning: they have no role in a democratic country. In any case, health activists, human rights lawyers and gender experts will combine to oppose all coercive measures and rightly so. This will only harm the cause of population stabilisation.

Bureaucracy is under the deadweight of files and reports. There is no time to read and reflect. Therefore they cannot generate new ideas. Nor can our ministers. This calls for a strong input of research and development (R&D). President Abdul Kalam relentlessly pleads for a knowledge-based society and India has a tremendous opportunity to emerge as a world knowledge power. The two apex organisations under the Central Ministry of Health and Family Welfare, namely, the National Institute of Health and Family Welfare (NIHFW) and the International Institute for Population Sciences (IIPS, Mumbai) are in bad shape. This is because of the mistaken perception of some bureaucrats in the Ministry that these institutions are like section offices in their department and must dance to their tune. These bureaucrats have no idea of research. These institutions must be made truly autonomous. The network of Population Research Centres funded by the Ministry of Health and Family Welfare, (originally visualised by the late Prof. V.K.R.V. Rao, founder of the Delhi School of Economics) are also in bad shape because of the unhelpful attitude of the Ministry.

Lack of research

Most of our demographers have become data gatherers for international donor agencies, lured by financial rewards of consultancy. In short, no worthwhile R&D is possible under the present set up. And without R&D large programmes like the National Rural Health Mission (NRHM) cannot be successful. We need innovative methods of monitoring and concurrent evaluation to be done independently. Otherwise, the money will be simply wasted and there will be large-scale corruption. Every state and the Centre too must have a Director of Vigilance (Health) to keep track of increasing corruption and medical malpractice by public and private doctors, pharmaceutical companies, insurance companies etc. The Government of Karnataka has created such a post and Dr. H. Sudarshan, an idealist and a dedicated doctor, who has an excellent record of working among tribes in remote areas, is occupying this post (on a salary of rupee one per month).

Suitable models

It is important to recognise that given India’s incredible diversity, there cannot be one model of healthcare or, for that matter, population stabilisation. We need over 600 models, one for every district. We already have several outstanding models like those of Dr. Raj Arole, Dr. Dayal Chand, Dr. N. H. Antia, and numerous others created by persons who are not so well known. Seek their advice in a big way. Also approach genuine NGOs who are working at the grassroot level like CEHAT, the Voluntary Health Association of India (VHAI) and other such dedicated organisations working in the field of health.

Population stabilisation efforts must take note of all the three variables which contribute to population growth, namely, fertility, mortality and migration. While we have a Health Policy (2002) and a Population Policy (2000), we have no migration policy. Every time the issue of illegal migration from Bangladesh crops up, several political parties with vested interests (vote bank) try to dilute the issue. This will not do. It is foolish to divide the number of migrants by India’s total population: you have to divide the figure by the population of the place where the migrants move in, legal or illegal. Unless you do that, you will not understand the demographic scene in North-Eastern India.

Finally, migration within the country, especially rural to urban, is equally important migration. There is a virtual collapse of the infrastructure in all our cities and towns. The urban collapse will be a greater disaster than tsunami. I was a member of the National Commission on Urbanisation and we submitted our report to Rajiv Gandhi in 1988 but after his tragic end nothing happened.

Do we have to wait for disasters for anything to happen? We had suggested that all million-plus cities and capitals of states and UTs should be declared as National Priority Cities (NPCs) and instead of pampering Delhi, we should have an integrated plan for all NPCs. In an era of globalisation this has assumed even greater urgency. Should we not have population stabilisation in our cities and towns? Given the low fertility rates in urban areas it is not fertility control but migration control that we need.

— The writer is Honorary Professor, Institute of Economic Growth, and a member of the National Commission on Population.