outline

OutlineNational Development VisionPopulation Situation and ContextPopulation and Development FactorsFamily Planning: ChallengesThe Role of Policy: Opportunities13245

Indias VisionEleventh Five-Year Plan (2007 2012)Commitment to planned social and economic developmentGovernmental role and responsibility

Our ultimate objective is to achieve broad based improvement in the living standards of all our people.

Millennium Development Goals (MDGs)Eight goals that respond to main development challengesProvide framework to measure and target development2015 deadline

Economy and SocietyHow does population affect Indias economic growth and social development in the coming decades?

Population

Indias population has quadrupled in the last 100 years. And the number of people added each decade continues to grow. Source: Census 2001: India at a GlancePopulation (million)Decadal Population Growth238Photo by Etrenard

In 20 years, India will be the most populous nation in the world.Source: World Population Prospects: 2008 Revision Population Database UN Population Division10 Most Populous Countries in the World Population (Millions)

Year 2008Year 2030 Photo by Andrew Miller

Uttar PradeshMaharashtraBiharWest BengalAndhra PradeshMadhya PradeshTamil NaduRajasthanGujaratOrissaKeralaJharkhandAssamPunjabHaryanaChhattisgarhDelhiJammu and KashmirUttaranchalPopulation of Indian states matches that of large countries...Sources: UN Population Prospects 2006 and R.G.I. Population Estimates 2006Note: Population in millionsBrazilMexicoGermanyVietnamPhilippinesThailandFranceItalySouth AfricaArgentinaCanadaUgandaUzbekistanPeruRomaniaGhanaCambodiaBelgiumAustria

Half the population growth will be in 7 northern states. Source: Registrar General of India, 2006 (Population Projections for India and States 2001 2026Projected population of India: 2001-2026Share of additional 371 millionSouthern states will contribute only 13% of growth.Photo by Meena Kadri

Source: Census 2001MaleFemale2001 Population (Crores) 8 6 4 2 0 2 4 6 8Indias Youth Bulge3 out of 10 people are under age 15Photos by PASQUA (top), Simply CVR (bottom)

Chart1

-6.50746845.8627623

-6.44335035.8455399

-6.17413415.7696192

-6.37379095.8404273

-6.12752655.4882216

-5.24974684.6940849

-4.49722014.2455642

-4.00082383.965237

-3.63676723.5801782

-3.25761353.076227

-2.72936182.4799736

-2.15036421.9437119

-1.5881461.5000631

-1.14065061.1965821

-0.83184960.9464407

-0.55208860.6376393

-0.37681130.4110033

Male

Female

Sheet1

2010MaleFemale

0-4-6.50746845.8627623

5-9-6.44335035.8455399

10-14-6.17413415.7696192

15-19-6.37379095.8404273

20-24-6.12752655.4882216

25-29-5.24974684.6940849

30-34-4.49722014.2455642

35-39-4.00082383.965237

40-44-3.63676723.5801782

45-49-3.25761353.076227

50-54-2.72936182.4799736

55-59-2.15036421.9437119

60-64-1.5881461.5000631

65-69-1.14065061.1965821

70-74-0.83184960.9464407

75-79-0.55208860.6376393

80+-0.37681130.4110033

By the time India achieves population stabilization, there will be 1.6 billion peopleSource: Census 2001; DemProj model analysis provided by USAID| Health Policy Initiative ProjectPhoto by Madhavi Kuram

Chart1

119.1209894

120.8632751

136.9870907

149.6265974

158.907474

164.244187

166.3852814

Population

Population in Billions

Sheet1

2010201120212031204120512061

Population119.1209894120.8632751136.9870907149.6265974158.907474164.244187166.3852814

Source: Registrar General of IndiaPopulation Explosion: Rapid Growth in Four States

Population Increase2009 Estimated PopulationAdditional Population in a DecadeTotal Population EquivalentMP(19.4%)69,897,000+5,941,245=MP + HPBihar(21.6%)95,026,000+12,027,000=Bihar + J&KUP(20.7%)193,763,000+27,565,000=UP + PunjabRajasthan (20.7%)65,650,000+9,143,000=Rajasthan + UttarakhandINDIA (10.9%)54,676,245=INDIA + GUJARAT

On average, women in northern states have more children.Source: SRS 2007 Total Fertility Rate, 2008Photo by Leandra Fallis

While some states have achieved replacement-level fertility, others will take many more years.Source: Registrar General of India, 2006 (Population Projections for India and States 2001 2026National Population Policy Goal

Total Fertility Rate2.1 by year 2010Photo by Meena Kadri

Fertility Trends: Madhya Pradesh, Bihar & Andhra PradeshSource: Sample Registration System (SRS), Registrar General of IndiaPhoto by Meena KadriChildren per woman

Population and development affect each otherPhoto by Simply CVRLink between population growth, development, and poverty alleviation goals

If we continue to grow at the current pace, our population will double in 50 years, making sustainable development unattainable.

Urgent need to reduce population growthSources: Census 2001 and 2008 Revision Population Database UN Population Division Population (billion)Photo by Meena Kadri

Development SectorsEducationEnvironment and Food SecurityWater and ElectricityEconomy and the Labour ForceHealthACBDE

EducationUniversal enrolment of children ages 614 including the hard- to-reach segmentAll gender, social, and regional gaps in enrolments to be eliminated by 201112Dropout at primary level to be eliminated Significant improvement in learning conditionsEleventh Five Year Plan 2007-2012

Primary StudentsFewer Students, More Resources Available per ChildHigh FertilityLow FertilityNumber of Students, Ages 6 11 (Millions)Projections arrived using SPECTRUM with inputs from Census, 2001, NFHS -2 & NFHS -3 and Eleventh five-year plan

Chart1

148.667174145.723358

192.267694134.2017

210.570951129.936132

227.48952120.836043

237.726998114.540453

Sheet1

High TFRReplacement TFR

201014.866717414.57234148.667174145.723358

203119.226769413.42017192.267694134.2017

204121.057095112.9936132210.570951129.936132

205122.74895212.0836043227.48952120.836043

206123.772699811.4540453237.726998114.540453

Primary TeachersFewer Teachers Needed, Better Student-to-Teacher RatioNumber of Teachers (Millions)High FertilityLow FertilityProjections arrived using SPECTRUM with inputs from Census, 2001, NFHS -2 & NFHS -3 and Eleventh five-year plan

Chart1

2.7211022.656979

4.5875823.178475

5.0439653.087067

5.4280612.867521

5.6777252.722788

High TFR

Replacement TFR

Sheet1

High TFRReplacement TFR

20102.7211022.656979

20314.5875823.178475

20415.0439653.087067

20515.4280612.867521

20615.6777252.722788

Education ExpendituresSignificant Savings with Slower Population GrowthExpenditures (INR Crores)High FertilityLow FertilityCumulative SavingsRs 5,43,015 CroresProjections arrived using SPECTRUM with inputs from Census, 2001, NFHS -2 & NFHS -3 and Eleventh five-year plan

Chart1

466.2806528455.2926208

480.871936462.1302784

497.2675072468.4983296

510.6262528471.2135168

524.4773376473.771776

538.7200512476.0481792

553.3416448479.145728

568.0254464482.8475392

582.5201664487.0084608

596.4488704491.3878528

609.7005056495.980544

617.2048896495.6254208

623.7159936494.264576

629.190144491.8532096

633.6732672488.4163072

637.2097536483.9815168

639.8382592478.574592

641.6136192472.2397696

643.3017344466.2066688

645.1671552460.5570048

647.469824455.3557504

650.4503296450.6600448

654.325248447.6058112

658.8409344445.3064192

663.9937024443.8141952

669.7768448443.1772672

676.1725952443.4942464

683.1655424443.3173504

690.7251712442.6347008

698.6950656441.4726144

706.9008384439.8552576

715.1584768437.6996864

723.2787456435.3686528

730.9630976432.7936512

738.0980736429.9165696

744.5881344426.6881536

750.3738368423.0716416

755.408128419.4844672

759.7497344415.9792384

763.482368412.6114048

766.7267584409.4467328

769.6175616406.5714944

772.3244544403.70048

774.9795328400.9022976

777.6964096398.2458624

780.585984395.8076416

783.7395968393.6787968

787.2270336391.8226432

791.097856390.1901056

795.3698816388.7259136

800.022016387.3679104

805.0161152386.0504576

India high TFR

India2016goallow TFR

Sheet1

India high TFRIndia2016goallow TFR

2010466.2806528455.2926208

2011480.871936462.1302784

2012497.2675072468.4983296

2013510.6262528471.2135168

2014524.4773376473.771776

2015538.7200512476.0481792

2016553.3416448479.145728

2017568.0254464482.8475392

2018582.5201664487.0084608

2019596.4488704491.3878528

2020609.7005056495.980544

2021617.2048896495.6254208

2022623.7159936494.264576

2023629.190144491.8532096

2024633.6732672488.4163072

2025637.2097536483.9815168

2026639.8382592478.574592

2027641.6136192472.2397696

2028643.3017344466.2066688

2029645.1671552460.5570048

2030647.469824455.3557504

2031650.4503296450.6600448

2032654.325248447.6058112

2033658.8409344445.3064192

2034663.9937024443.8141952

2035669.7768448443.1772672

2036676.1725952443.4942464

2037683.1655424443.3173504

2038690.7251712442.6347008

2039698.6950656441.4726144

2040706.9008384439.8552576

2041715.1584768437.6996864

2042723.2787456435.3686528

2043730.9630976432.7936512

2044738.0980736429.9165696

2045744.5881344426.6881536

2046750.3738368423.0716416

2047755.408128419.4844672

2048759.7497344415.9792384

2049763.482368412.6114048

2050766.7267584409.4467328

2051769.6175616406.5714944

2052772.3244544403.70048

2053774.9795328400.9022976

2054777.6964096398.2458624

2055780.585984395.8076416

2056783.7395968393.6787968

2057787.2270336391.8226432

2058791.097856390.1901056

2059795.3698816388.7259136

2060800.022016387.3679104

2061805.0161152386.0504576

Better EducationWith Less Population PressureMore resources for training and incentives to keep teachers in rural areasMore resources for classrooms and educational materialSmaller classrooms and better learning environmentsProgress on MDG 2:Achieve universal primary education

Futures Group - First mention of the MDGs. If important, then consider slide at the introduction that frames the presentation around making progress towards MDGs as well as India's Development Plan.

Environment and Food SecurityGoals:

Accelerate the agricultural growth rate of 4% per annum during 2007-12

Increase the foodgrains production by at least 20 million tonnes by 2012Eleventh Five Year Plan 2007-2012

Lower ProductivityEnvironmentalDegradationLarger Population Leads to Overuse of LandOverexploitationDeforestationErosionPoorer soil fertilityPhoto by Bron

Land FragmentationHigher Population, Less Land per HolderLand holdings divided among more family membersLower productivity from small farms less food securityPhotos by Sankara Subramanian (top), Simply CVR (bottom)

UndernourishmentLarger Population, Greater Demand for Food1 out of 5 people do not have enough to eat

Less food per personPhoto by World BankSource: Food and Agriculture Organization, Statistics Division

Sources: India Economic Survey; Department of Food and Public Distribution; Authors calculationsTargeted Public Distribution SystemMore Families Will Require Food SubsidiesPopulation Requiring Subsidies (Millions)High FertilityLow Fertility

Chart1

133.691074131.01331

162.03418150.685799

188.02344164.58926

215.062254174.798217

241.467182180.668609

267.484602183.023808

Sheet1


201013.369107413.101331133.691074131.01331

201113.618492813.2949608136.184928132.949608

201213.870994513.4855402138.709945134.855402

201314.126201113.674606141.262011136.74606

201414.383697913.8617226143.836979138.617226

201514.64277114.0461827146.42771140.461827

201614.903212514.227763149.032125142.27763

201715.164052214.4054966151.640522144.054966

201815.424874314.5788841154.248743145.788841

201915.685313614.7474954156.853136147.474954

202015.945075314.9109774159.450753149.109774

202116.20341815.0685799162.03418150.685799

202216.461518715.2227647164.615187152.227647

202316.719672215.3732326167.196722153.732326

202416.978186515.5196833169.781865155.196833

202517.237388315.6618792172.373883156.618792

202617.496561515.8016793174.965615158.016793

202717.756110915.9390055177.561109159.390055

202818.016258716.0736565180.162587160.736565

202918.277228216.2054211182.772282162.054211

203018.539211916.3342751185.392119163.342751

203118.80234416.458926188.02344164.58926

203219.067610116.5799282190.676101165.799282

203319.334772616.6971365193.347726166.971365

203419.603691816.8105201196.036918168.105201

203519.874108116.9198711198.741081169.198711

203620.145646417.0249002201.456464170.249002

203720.417948117.1254666204.179481171.254666

203820.69060417.2213778206.90604172.213778

203920.963101517.3123577209.631015173.123577

204021.235109517.3981885212.351095173.981885

204121.506225417.4798217215.062254174.798217

204221.776108217.5571209217.761082175.571209

204322.044700717.6301499220.447007176.301499

204422.311812617.6988317223.118126176.988317

204522.57735717.7630651225.77357177.630651

204622.841506617.8231328228.415066178.231328

204723.104391217.8791943231.043912178.791943

204823.366082317.9313519233.660823179.313519

204923.626886817.9799037236.268868179.799037

205023.887045618.0250763238.870456180.250763

205124.146718218.0668609241.467182180.668609

205224.406242318.1053576244.062423181.053576

205324.665811518.1405895246.658115181.405895

205424.925466518.172495249.254665181.72495

205525.185429518.2012094251.854295182.012094

205625.445757718.2267063254.457577182.267063

205725.706290518.2488119257.062905182.488119

205825.967045518.2675471259.670455182.675471

205926.227856618.2828217262.278566182.828217

206026.488377318.2944124264.883773182.944124

206126.748460218.3023808267.484602183.023808

Future Expenditure on Food SubsidiesGreater Pressure to Provide SubsidiesExpenditure on Subsidy (INR Crores)High FertilityLow FertilitySources: India Economic Survey; Department of Food and Public Distribution; Authors calculationsCumulative SavingsRs 6,21,881 Crores

Chart1

45494.5009344590

46343.1487945242.18322

47202.4012845890.71677

48070.8584346534.09961

48947.1090347170.8494

49828.7237147798.55923

50714.99548416.46923

51602.6213549021.28907

52490.1878149611.31932

53376.4516150185.09637

54260.4095750741.41862

55139.5387351277.73319

56017.8443851802.41748

56896.329752314.45331

57776.0428252812.81878

58658.0954653296.70535

59540.0507853772.43911

60423.2862954239.7543

61308.5581354697.9659

62196.6261855146.3552

63088.1455255584.83985

63983.572856009.02153

64886.26256420.78685

65795.4045756819.64168

66710.5251157205.48122

67630.7402257577.598

68554.7734457935.00754

69481.4044958277.2307

70409.2408658603.61241

71336.538258913.21312

72262.1697959205.29167

73184.7656159483.08596

74103.1652459746.13183

75017.1740459994.64639

75926.1444160228.36762

76829.7806560446.95114

77728.6704560651.35895

78623.2555160842.13384

79513.7791361019.62392

80401.2856961184.84362

81286.5949761338.56405

82170.2497361480.75526

83053.3991461611.75788

83936.7020361731.65053

84820.296961840.22358

85704.9398761937.93746

86590.8256162024.70232

87477.4075962099.92673

88364.7457162163.68182

89252.2747362215.66063

90138.8155362255.10328

91023.8665262282.21941

India high TFR


Sheet1


201045494.5009344590904.50093

201146343.1487945242.183221100.96557

201247202.4012845890.716771311.68451

201348070.8584346534.099611536.75882

201448947.1090347170.84941776.25963

201549828.7237147798.559232030.16448

201650714.99548416.469232298.52577

201751602.6213549021.289072581.33228

201852490.1878149611.319322878.86849

201953376.4516150185.096373191.35524

202054260.4095750741.418623518.99095

202155139.5387351277.733193861.80554

202256017.8443851802.417484215.4269

202356896.329752314.453314581.87639

202457776.0428252812.818784963.22404

202558658.0954653296.705355361.39011

202659540.0507853772.439115767.61167

202760423.2862954239.75436183.53199

202861308.5581354697.96596610.59223

202962196.6261855146.35527050.27098

203063088.1455255584.839857503.30567

203163983.572856009.021537974.55127

203264886.26256420.786858465.47515

203365795.4045756819.641688975.76289

203466710.5251157205.481229505.04389

203567630.7402257577.59810053.14222

203668554.7734457935.0075410619.7659

203769481.4044958277.230711204.17379

203870409.2408658603.6124111805.62845

203971336.538258913.2131212423.32508

204072262.1697959205.2916713056.87812

204173184.7656159483.0859613701.67965

204274103.1652459746.1318314357.03341

204375017.1740459994.6463915022.52765

204475926.1444160228.3676215697.77679

204576829.7806560446.9511416382.82951

204677728.6704560651.3589517077.3115

204778623.2555160842.1338417781.12167

204879513.7791361019.6239218494.15521

204980401.2856961184.8436219216.44207

205081286.5949761338.5640519948.03092

205182170.2497361480.7552620689.49447

205283053.3991461611.7578821441.64126

205383936.7020361731.6505322205.0515

205484820.296961840.2235822980.07332

205585704.9398761937.9374623767.00241

205686590.8256162024.7023224566.12329

205787477.4075962099.9267325377.48086

205888364.7457162163.6818226201.06389

205989252.2747362215.6606327036.6141

206090138.8155362255.1032827883.71225

206191023.8665262282.2194128741.64711

621881.00179

Water and ElectricitySustainabilityAdequate safe drinking water facilities should be provided to the entire population both in urban and in rural areas.- National Water Policy, 2002Source: Ministry of Water Resources

Access to Safe Drinking WaterLess Demand for Water with Lower FertilityProjections arrived using SPECTRUM with inputs from Census, 2001, NFHS -2 & NFHS -3 and Ministry of Water Resources People Without Access (Millions)

ElectricityElectricity Consumption(Billions Kilowatt Hours)Low FertilityHigh FertilityLess Demand with Lower FertilitySources: U.S. Energy Information Administration, India Energy Profile

Chart1

751.6534469766.9006154

855.3478854914.6675013

936.99341711063.4766099

998.02335851218.1230995

1033.98392231370.2477976

1049.89111681534.3889442


India high TFR

Sheet1

Electricity consumption (kilowatt hours) BILLIONS2001200220032004200520062007200820092010201120122013201420152016201720182019202020212022202320242025202620272028202920302031203220332034203520362037203820392040204120422043204420452046204720482049205020512052205320542055205620572058205920602061

India2016goallow TFR6496616736846967077197307417527637747847958068168268368468558648738828908989069149229309379449519589649719779829889939981,0031,0071,0111,0151,0191,0221,0261,0291,0311,0341,0361,0391,0411,0421,0441,0461,0471,0481,0491,0491,050

India high TFR6496616746866997127257397537677817968108258408558708859009159299449599749891,0041,0191,0331,0481,0631,0791,0941,1091,1251,1401,1561,1711,1871,2031,2181,2341,2491,2651,2801,2951,3101,3251,3401,3551,3701,3851,4001,4151,4301,4451,4601,4751,4901,5051,5191,534

EconomyGoals:Increase average GDP growth rate to 9% per year

Reduce unemployment among the educated to less than 5%

Increase local wage rate of unskilled workers by 20%

Reduce head-count ratio of consumption poverty by 10%Eleventh Five Year Plan 2007-2012

Labour ForceUnemployment, Underemployment Eight percent of population is unemployedPopulation with formal education are unable to find jobsMigration to cities in search of employmentPhoto by McKay Savage

EmploymentNumber of People Seeking Employment Will Continue to RiseTotal Labour Force (Millions)Projections arrived using SPECTRUM with inputs from Census, 2001, NFHS -2 & NFHS -3

Chart1

552.253376552.253376

571.907456571.907456

591.209856591.194816

610.68448610.647872

630.270336630.214592

650.012352649.949248

669.859072669.811072

691.77984691.335808

703.9008702.66464

716.142016713.700224

728.515648724.438016

741.015488734.852672

753.659136744.941056

766.45632754.692288

779.411584764.08928

792.510464773.32864

805.686016782.339008

818.883072791.065792

832.072799.478528

845.241152807.564096

858.386432815.318656

871.497856822.732352

884.540864829.771904

897.482304836.398208

910.299456842.584192

922.968896848.30336

935.465216853.52992

947.870592858.435968

960.202176862.998592

972.479104867.193664

984.725056871.0064

996.95168874.626048

1009.186304878.046336

1021.434304881.242816

1033.676288884.165824

1045.881856886.768448

1058.032896888.930688

1070.164032890.658432

1082.262272891.944768

1094.27136892.741376

1106.11584892.977216

1117.74528892.609472

1129.12891.614976

1140.263424890.032832

1151.256192887.962112

1162.226944885.540032

1173.26656882.955456

1184.417152880.26624

1195.68832877.493184

1207.049472874.612992

1218.480384871.60576

1229.99616868.496128

Sheet1


200139.002169639.0021696390.021696390.021696

200240.610806440.6108064406.108064406.108064

200342.284483242.2844832422.844832422.844832

200444.018188844.0181888440.181888440.181888

200545.803225645.8032256458.032256458.032256

200647.625033647.6250336476.250336476.250336

200749.47836849.478368494.78368494.78368

200851.363094451.3630944513.630944513.630944

200953.277939253.2779392532.779392532.779392

201055.225337655.2253376552.253376552.253376

201157.190745657.1907456571.907456571.907456

201259.120985659.1194816591.209856591.194816

201361.06844861.0647872610.68448610.647872

201463.027033663.0214592630.270336630.214592

201565.001235264.9949248650.012352649.949248

201666.985907266.9811072669.859072669.811072

201769.17798469.1335808691.77984691.335808

201870.3900870.266464703.9008702.66464

201971.614201671.3700224716.142016713.700224

202072.851564872.4438016728.515648724.438016

202174.101548873.4852672741.015488734.852672

202275.365913674.4941056753.659136744.941056

202376.64563275.4692288766.45632754.692288

202477.941158476.408928779.411584764.08928

202579.251046477.332864792.510464773.32864

202680.568601678.2339008805.686016782.339008

202781.888307279.1065792818.883072791.065792

202883.207279.9478528832.072799.478528

202984.524115280.7564096845.241152807.564096

203085.838643281.5318656858.386432815.318656

203187.149785682.2732352871.497856822.732352

203288.454086482.9771904884.540864829.771904

203389.748230483.6398208897.482304836.398208

203491.029945684.2584192910.299456842.584192

203592.296889684.830336922.968896848.30336

203693.546521685.352992935.465216853.52992

203794.787059285.8435968947.870592858.435968

203896.020217686.2998592960.202176862.998592

203997.247910486.7193664972.479104867.193664

204098.472505687.10064984.725056871.0064

204199.69516887.4626048996.95168874.626048

2042100.918630487.80463361009.186304878.046336

2043102.143430488.12428161021.434304881.242816

2044103.367628888.41658241033.676288884.165824

2045104.588185688.67684481045.881856886.768448

2046105.803289688.89306881058.032896888.930688

2047107.016403289.06584321070.164032890.658432

2048108.226227289.19447681082.262272891.944768

2049109.42713689.27413761094.27136892.741376

2050110.61158489.29772161106.11584892.977216

2051111.77452889.26094721117.74528892.609472

2052112.91289.16149761129.12891.614976

2053114.026342489.00328321140.263424890.032832

2054115.125619288.79621121151.256192887.962112

2055116.222694488.55400321162.226944885.540032

2056117.32665688.29554561173.26656882.955456

2057118.441715288.0266241184.417152880.26624

2058119.56883287.74931841195.68832877.493184

2059120.704947287.46129921207.049472874.612992

2060121.848038487.1605761218.480384871.60576

2061122.99961686.84961281229.99616868.496128

Better EconomyWith Less Population PressureMore funding for social sectorGreater disposable family income for education and healthLower youth unemploymentGreater stabilityProgress on MDGs1: Eradicate extreme poverty and hunger

Photo by Ford APA

HealthGoals:Reducing Maternal Mortality Ratio (MMR) to 100 per 100,000 live birthsReducing Infant Mortality Rate (IMR) to 28 per 1000 live birthsReducing Total Fertility Rate (TFR) to 2.1Eleventh Five Year Plan 2007-2012Photo by World Bank

Decline in the national maternal mortality ratio is small compared to the goalSource: Special Bulletin on Maternal Mortality in India 2004-06, Sample Registration System, Office of Registrar General, India. April 2009.Maternal deaths per 100,000 live birthsRate of decline needs to be faster to meet the MDGPhotos by Uvrish Joshi (top), Sara Anderson (bottom)

State Maternal Mortality RatioStates need to invest inquality health care services and empower women to demand their reproductive and health rights

Source: Special Bulletin on Maternal Mortality in India 2004-06, Sample Registration System, Office of Registrar General, India. April 2009.Maternal deaths per 100,000 live births

Source: SRSPhoto by Matthieu A.Infant deaths per 1,000 live birthsState Infant Mortality Rate

Population with Specific Needs Women of Childbearing Age and Children Under FiveWomen and Children (Millions)High FertilityLow FertilityProjections arrived using SPECTRUM with inputs from Census, 2001, NFHS -2 & NFHS -3 and Eleventh five-year plan

NursesLess Pressure on Health ProvidersNurses Needed (Millions)High FertilityLow FertilityProjections arrived using SPECTRUM with inputs from Census, 2001, NFHS -2 & NFHS -3 and Medical Council of India

Chart1

1.9328461.894418

2.6782512.490674

3.1078252.720484

3.5547482.889227

3.9911932.986258

4.4212333.025187

India high TFR


Sheet1


20101.9328461.894418

20111.9939521.946582

20122.0570961.999932

20132.1222942.054447

20142.18922.109755

20152.2585022.166484

20162.3299012.224304

20172.4033312.283108

20182.4783692.342441

20192.5559022.403085

20202.635552.464625

20212.6782512.490674

20222.7209122.51616

20232.7635822.54103

20242.8063122.565237

20252.8491552.588741

20262.8919942.611848

20272.9348942.634546

20282.9778942.656803

20293.021032.678582

20303.0643332.69988

20313.1078252.720484

20323.1516712.740484

20333.195832.759857

20343.240282.778599

20353.2849772.796673

20363.3298592.814033

20373.3748682.830656

20383.4199352.846509

20393.4649752.861547

20403.5099362.875734

20413.5547482.889227

20423.5993572.902004

20433.6437522.914075

20443.6879032.925427

20453.7317952.936044

20463.7754562.945972

20473.8189082.955239

20483.8621632.96386

20493.9052712.971885

20503.9482722.979352

20513.9911932.986258

20524.034092.992621

20534.0769942.998445

20544.1199123.003718

20554.1628813.008464

20564.205913.012679

20574.2489743.016333

20584.2920743.019429

20594.3351833.021954

20604.3782443.02387

20614.4212333.025187

Health ExpendituresLess Pressure on Health ServicesINR (Crores)High FertilityLow FertilityCumulative SavingsRs 5,38,200 CroresProjections arrived using SPECTRUM with inputs from Census, 2001, NFHS -2 & NFHS -3 and MoHFW

Chart1

814814

854834

908883

925895

941907

958919

975931

993943

1010954

1027965

1044976

1061986

1077996

10941006

11111016

11281025

11451034

11621043

11791052

11961061

12131069

12311077

12481085

12661093

12831100

13011107

13191114

13361121

13541127

13721133

13901139

14081144

14251149

14431154

14601158

14781163

14951167

15121170

15291174

15461177

15641180

15811183

15971185

16141187

16311189

16491191

16661193

16831194

17001196

17171197

17341197

17511198

India high TFR


Sheet1


2010814814

2011854834

2012908883

2013925895

2014941907

2015958919

2016975931

2017993943

20181010954

20191027965

20201044976

20211061986

20221077996

202310941006

202411111016

202511281025

202611451034

202711621043

202811791052

202911961061

203012131069

203112311077

203212481085

203312661093

203412831100

203513011107

203613191114

203713361121

203813541127

203913721133

204013901139

204114081144

204214251149

204314431154

204414601158

204514781163

204614951167

204715121170

204815291174

204915461177

205015641180

205115811183

205215971185

205316141187

205416311189

205516491191

205616661193

205716831194

205817001196

205917171197

206017341197

206117511198

Improved HealthWith Less Population PressureMore resources to train staff, retain staff, and improve facilitiesFewer maternal and child deathsProgress on MDGs4: Reduce child mortality5: Reduce maternal mortality6: Combat HIV/AIDS and malaria

Photos by Stephane Tougard (top), Suneeta Sharma (bottom)

Source: DLHS-3 (2007-08), IIPS MumbaiUse of Family Planning MethodsHigh percentage of non- contraceptive users indicates a gap in service delivery Photo by Anonymous

Number of Children at Sterilisation or Use of IUCD BiharSource: NFHS-3 (2005-06), IIPS MumbaiPhoto by Amre Ghiba

Northern states hold the key to reducing fertility because of the large unmet need for family planning. By simply meeting unmet need for contraceptives, India can achieve replacement level fertility.Photo by Shreyans BansaliSource: Institute for population Sciences (IIPS), 2006. District Level Household Survey (DLHS-2), 2002-04: India & DLHS 3 (2007-08), IIPS, Mumbai

Chart1

11.58.5

11.211.6

15.115.8

18.215.9

15.116.8

22.117.9

20.219.3

18.119.4

16.619.8

22.120.9

19.824

43.127

34.333.8

34.234.7

38.337.2

DLHS-II

DLHS-III

Sheet1

DLHS-IIDLHS-III

Andhra Pradesh11.58.5

West Bengal11.211.6

Karnataka15.115.8

Sikkim18.215.9

Kerala15.116.8

Rajasthan22.117.9

Madhya Pradesh20.219.3

Tamil Nadu18.119.4

Pondicherry16.619.8

Chattisgarh22.120.9

Orissa19.824.0

Goa43.127.0

Uttar Pradesh34.333.8

Jharkhand34.234.7

Bihar38.337.2

Meeting unmet need will avert nearly12 lakhs infant deaths11,79,615 child deaths avertedSource: Sample Registration System, Registrar General of India, MDG analysis provided by USAID|Health Policy Initiative ProjectPhoto by Daniela Hartman

Chart1

6196168

5016554

Maternal deaths

Number of infant deaths averted due to increased use of family planning (2010-2015)

Sheet1

BaseNeed met

Maternal deaths6,196,1685,016,554

Meeting the unmet need will avert nearly 35,000 maternal deaths34,872 maternal deaths avertedPhoto by McKay SavageSource: Sample Registration System, Registrar General of India, Maternal Mortality in India, MDG analysis provided by USAID|Health Policy Initiative Project

Chart1

298274

263402

Maternal deaths

Number of maternal deaths averted due to increased use of family planning (2010-2015)

Sheet1

BaseNeed met

Maternal deaths298,274263,402

Meeting unmet need to achieve MDGs:Social sector cost savings outweigh family planning costsPhoto by Shreyans BhansaliSource: Sample Registration System, Registrar General of India, MDG analysis provided by USAID|Health Policy Initiative Project

Moving Forward: Understanding ChallengesPhoto by Aayushi Mehta

Source: DLHS-3 (2007-08), IIPS MumbaiPercentage of women married before age 18Married while still a child denies a girl her basic human rights for health and educationPhoto by Entrenard

Source: NFHS-3 (2005-06), IIPS MumbaiPercentage of teenage girls in India who are pregnant or already mothers

Pregnant teenage girls are at high risk of death or disability

AgePhoto by Living Water International

Source: DLHS-3 (2007-08), IIPS MumbaiPercentage of teenage girls who are pregnant or already mothersGirls with less than 10 years of education are not able to exercise their reproductive rights

Fertility declines with increase in education levels of girls.Photo by Meena Kadri

Education Status of Rural Unmarried Women (age 15-24)Source: DLHS-3 (2007-08), IIPS MumbaiSeven in 10 women in high-fertility states have less than 10 years of education.Photo by Michael Foley

Early onset and long periods of fertility affect mother and child health Source: NFHS-3 (2005-06), IIPS MumbaiBirths per thousand womenTamil Nadu1.7 children average Andhra Pradesh 2.0 children averageJharkhand3.4 children averagePhoto by Akshay Mahajan Age-Specific Fertility Rates for Jharkhand, Tamil Nadu, and Andhra Pradesh

Too young, Too old, Too many, Too soon

High-risk births lead to high infant mortality

Delay child marriages and promote birth spacingSource: NFHS 3 (2005-06), IIPS MumbaiMothers AgeBirth OrderBirth Spacing (yrs)Photos by Uvrish Joshi (top), Trey Ratcliff (bottom)Infant deaths per 1,000 live births

Opportunities:PolicyLeadershipFinancial resourcesDemandThe Way Forward:Critical Role of Elected RepresentativesPhotos by Simply CVR (top), Suneeta Sharma (bottom)

National policies recognize role of FP in meeting health and development goals.

Eleventh Five Year Plan (2007 2012)Population Policy of India (2000)Asean-India Vision - 2020Millennium Development Goals (2015)Photo by Bernard Oh

Elected Representatives Can Make A Difference

Actions in Parliament:Safeguard FP line item in NRHMInclude Family Planning in Central Vigilance & Monitoring Committees mandateEnsure accountability of health system performancePromote parliamentary discussions on issues related to population and developmentSupport laws that work for the empowerment of womenForm youth brigade on delaying and spacing childrenPromote FP as part of the maternal and child health programme


Actions in State:Converge population with other development programmesPromote information-based decision-making, monitoring, and feedback on all social sectors initiativesStrengthen performance reports in health and family planningIncrease awareness and enforcement of Child Marriage Restraint ActEmphasize population stabilisation at all forumsScale up of best practisesEngage civil society to take ownership


Actions in Constituency:Target underserved communities for health and family planningPromote private sector partnerships to augment health deliveryEncourage male involvement in family planning through shared decision-makingEnsure girls do not drop out of schoolEmpower women through secondary education and job opportunitiesStop discrimination against girl child and gender based violence

Take A Lead NowImplement policySupport leadershipUtilize financial resourcesMeet demandSource: NFHS - 3 (2005-06), IIPS MumbaiPhoto by Dey Alexander

Chart1

2.68

1.9

2006

Sheet1

Current TFRWanted TFR

20062.71.9

Let us join hands to save our mothers and children.We make a living by what we get; we make a life by what we give! Photo by Vikram Singh

Photo by Alosh BennettThank YouProgress through Family PlanningIndiaSupport for this presentation was provided by theUSAID | Health Policy Initiative, Task Order 1Dr Amarjit Singh

Executive Director, Jansankhya Sthirata Kosh (National Population Stabilisation Fund)

Today I will present an analysis which looks at the impacts of population growth on various aspects of development education, health, employment, access to safe water and agriculture. It also considers the role of family planning to improve maternal and child health and lower population growth.

Technical Note: Analyses were conducted using the FAMPLAN, RAPID, and DemProj modules within SPECTRUM Suite for simulation modeling.*The presentation is divided into five parts:

The first part looks at Indias population and development objectives as defined through the Eleventh Five Year Plan and the Millennium Development Goals (MDGs). The second part considers the population situation in the country we shall examine the Indian population dynamic within a national and regional context.The third part is a general discussion about relationships between population and development. We link population characteristics to several development factors while keeping Indias own development goals in mind. The fourth part explores the relationships between family planning, contraceptive use, population, and development. We shall also identify some of the challenges that India faces in achieving its FP and development goals.Finally, the last section considers the role of policy and policy responses to development issues. Effective policy and advocacy present opportunities that can overcome barriers to meeting Indias development objectives.

Lets begin by examining Indias vision and development goals.*The Eleventh Five Year Plan and the Millennium Development Goals (MDGs) guide Indias primary development objectives.

The Eleventh Five Year Plan reaffirms Indias commitment to economic development by improving the economic conditions at the national and sub-national levels and affirming the role of the government in bringing about positive outcomes through a variety of social, economic, and institutional means. It provides a comprehensive strategy for inclusive development, building on the growing strength of the economy, while also addressing weaknesses that have surfaced.

This analysis examines the impact of high population growth on 4 of the 8 MDGs.

Technical Note:The Millennium Development Goals (MDGs) are eight goals to be achieved by 2015 that respond to the world's main development challenges. The eight MDGs break down into 21 quantifiable targets that are measured by 60 indicators.Goal 1: Eradicate extreme poverty and hunger Goal 2: Achieve universal primary education Goal 3: Promote gender equality and empower women Goal 4: Reduce child mortality Goal 5: Improve maternal health 5A: Reduce by three-quarters, between 1990 and 2015, the maternal mortality ratio 5.1 Maternal Mortality Ratio5.2 Proportion of births attended by skilled health personnel5B: Achieve, by 2015, universal access to reproductive health5.3 Contraceptive prevalence rate5.4 Adolescent birth rate5.5 Antenatal care5.6 Unmet need for family planningGoal 6: Combat HIV/AIDS, malaria and other diseases Goal 7: Ensure environmental sustainability Goal 8: Develop a Global Partnership for Development

*In order to adequately respond to the key question, lets examine some key population characteristics of India. Given Indias development objectives, this section of the presentation answers the following question: what is the importance of population factors on Indias ability to achieve its economic and social development goals in the coming decades?*Indias population has quadrupled in the last century, from 238 million people to over 1 billion in 2001. And the number of people added each decade continues to grow. moreover, within 20 years, India could overtake China as the most populous nation in the world.*This chart shows that the populations of several Indian states match, and in some cases, exceed those of several large countries. For example, the population of Uttar Pradesh is almost that of Brazil the 5th most populous country in the world. Seven states in the north will contribute to half of all population growth between 2001 and 2026; in contrast, the four southern states combined will contribute to only 13% of all population growth during the same period.

Technical Note:Northern states: (Uttar Pradesh, Uttarakhand, Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, and Rajasthan) Southern states: (Kerala, Karnataka, Andhra Pradesh and Tamil Nadu)

371 million = additional population from 2001 to 2026. Percents represent each states share of 371 million. For example, Uttar Pradesh contributes 22% of Indias total population growth (371 million) between 2001 and 2026. Furthermore, India has a very young population because birth rates have been so high for a long time.

About 30 percent of the population is under the age of 15 (represented by the black bars) this young age structure creates a powerful momentum for future population growth. How so? These large numbers of females (ages 0 to 15, from the black bars) will soon enter their reproductive years. This implies that many couples will be having children. Therefore, even if fertility declines rapidly, it will take 50 years for the population to stabilize.

The young age structure also has important development implications. It creates a high child dependency ratio that places a heavy burden on the working age population, represented by the dark blue bars, and could constrain the provision of basic needs and social services. **Indias population is increasing at an annual rate of 1.4% (SRS); however, several states populations are increasing at an even faster rate.

These equations look at each states current population plus the additional population that will accrue in a decade if current trends continue.

For example, lets look at Madhya Pradesh (MP):MPs current population is 69.9 million and will increase by 19.4% in ten years. The state will add another 5.9 million people in 10 years. This is like adding the equivalent of Himachal Pradesh (HP)s current population to MP.

Similarly, in ten years: Bihars population would increase by as much as Jammu and Kashmir (J&K)s current populationUttar Pradesh (UP)s population would increase by as much as Punjabs current population, and Rajasthan would increase by an equivalent of Uttarakhands population.

If we were to look at the cumulative contributions of just these four states, in the next decade, India would increase by more than 54 million people. This is like adding the entire state of Gujarat to the current population.*The fertility rate impacts population size.

This map illustrates total fertility rates (TFR) across Indias states. Several states in north continue to have high fertility rate, while southern states have achieved replacement level fertility (2.1 children per woman). Consequently, high population growth can be expected from states with high fertility.As stated in Indias National Population Policy, the goal was to achieve a TFR of 2.1 (replacement fertility) by 2010. While several states (those highlighted in blue) achieved this goal it will take other states many more years. In some cases, such as Uttar Pradesh and Madhya Pradesh, achieving replacement level fertility could take at least another 15 years.

For example, Kerala achieved replacement fertility in 1988, indicated by a full blue segment. Haryana is expected to achieve replacement level fertility in two years (2012) illustrated by a partially filled blue segment. On the other hand, it will be at least another 25 years before UP can expect to attain replacement level fertility.

Technical Note:The outside ring represents achievement of replacement fertility (2.1 children per woman). Each slice represents a state. The years in parentheses estimates the year in which replacement fertility will be achieved. The goal stated in Indias National Population Policy was to achieve a TFR of 2.1 (replacement-level fertility) by 2010. While several states (those highlighted in blue) achieved this goal, it will take other states many more years. In some cases, such as Uttar Pradesh and Madhya Pradesh, achieving replacement-level fertility could take at least another 15 years.

For example, Kerala achieved replacement fertility in 1988, indicated by a full blue segment. Haryana is expected to achieve replacement level fertility in two years (2012) illustrated by a partially filled blue segment. On the other hand, it will be at least another 25 years before UP can expect to attain replacement-level fertility.

Technical Note:The outside ring represents achievement of replacement fertility (2.1 children per woman). Each slice represents a state. The years in parentheses estimates the year in which replacement fertility will be achieved. The following graph examines fertility trends from 1991 to 2007, using MP, Bihar, and AP as examples. As the graph indicates, these three states have shown a decline in fertility over the last 20 years; however, the degree to which each state has made progress on reducing its fertility rate is varied. Since 1991, fertility has declined by about one child per woman in MP and AP but Bihar has shown a smaller decline. Bihar has made the least progress in reducing its fertility rate, dropping from 4.4 to 3.9 children per woman. MP has made more progress, reducing fertility from 4.6 to 3.4 children per woman. AP has achieved replacement fertility.

**The third part of the presentation is a general discussion of the relationship between population and development. Given our examination of Indias current population situation, we shall project possible population scenarios and observe the effects on socioeconomic factors.*The following analyses are based on two population projections. These projections assume different fertility scenarios. The black bars represent population growth over the next 50 years if fertility were lowered to replacement level (2.1 children per woman) by 2021. The blue bars represent population growth if high fertility continues. These two scenarios will be used throughout this section of the presentation in order to demonstrate the impact of fertility on population and development.

If no actions are taken to reduce fertility, in fifty years, Indias population would double that of today. Let us now look at the impact of high and low fertility scenarios on Indias development.

Technical Notes:All of the data presented begins in 2010; however, all projections begin in 2001 in order to coincide with the 2001 census. This explains the difference in the 2010 data points.Low fertility scenario assumes that in 2001, the TFR is 3.2 children per woman, decreasing to replacement fertility level by 2021, and decreasing further to 1.9 by 2061.High fertility scenario assumes a TFR of 3.2 in 2001, decreasing to 2.5 in 2061.*Lets now examine the relationship between population growth and development. We will look at five sectors:-EducationEnvironment and Food SecurityWater and ElectricityEconomy and the labour forceHealth

To do so, we are going to use two population projections in which we shall observe the effects of continued high fertility (represented in blue) versus a decline in fertility towards replacement level (represented in black). *Indias Eleventh Five Year Plan (2007 2012) lays out some important and ambitious goals for improving access to high-quality education. These goals are: Achieve universal enrolment of children ages 614 including the hard- to-reach segmentErase all gender, social, and regional gaps in enrolmentsEliminate t primary level dropout rates Improve learning conditions

What impact would continued population growth have on Indias ability to achieve these goals? As an example, lets consider universal enrolment of 6 to 14 year olds under the two fertility scenarios.*In 50 years, there would be 123 million fewer primary students under the low fertility scenario. Fewer students means that resources invested in teachers and facilities in order to improve the quality of education.

Technical notes: The projections assume that gross enrolment for primary school was 89% in 2001; this increases to 100% by 2020 and remains at 100% until 2061. It is assumed that age of entry into primary school is 6 years old and that primary school last 5 years. *With 123 million fewer primary students, fewer teachers will be needed 5.7 versus 2.7 million by 2061. This improves the quality of education by reducing the student-to-teacher ratio.

Technical note: It is assumed that in 2001 there were 43 students to primary school teacher and this decreases to 35 students per teacher by 2020 and remains at that ratio until 2061.

*Lower fertility would result in significant cost savings (fewer students would mean less teachers and facilities needed). Between 2010 and 2061, the government could realize a cumulative cost savings of Rs 543, 000 crores.

Technical note: It is assumed that the cost per primary student is USD $40.51 in 2001 and remains constant until 2061 (Prime Ministers Council on Trade and Industry). INR = Indian RupeesThis cost savings would mean more resources are available for teachers and learning materials, including smaller classroom sizes. These investments would help India achieve its education goals as well as make progress on the MDGs target for universal primary education.**To help ensure a productive agricultural environment for socio-economic development, including food security, would require India to:

1) accelerate its agricultural growth rate to 4% per year between 2007 and 2012, and2) increase production of food grains by 20 millions tons by 2012.India occupies only 2.4% of the world's land area, yet it supports over 17.5% of the world's population*. The growing pressure on this land is leading to overexploitation, deforestation, erosion, loss of soil fertility all of which contribute to lower productivity. How so? (next slide)

*(Library of Congresss Country Profile: India (December 2004))*Land fragmentation occurs when families must divide their land among ever larger numbers of descendents. Intensive cultivation leads to lower crop yields and shrinks natural food resources, decreasing agricultural and economic productivity and exacerbating food insecurity and household poverty.*Food security is an issue in India. Twenty-two percent of the population is undernourished.* Continued high population growth will further fuel the demand for food and land when commodities and resources are already scarce.

*Food and Agriculture Organization, Statistics Division. **Forty percent of Indias poor are provided a food subsidy through the Target Public Distribution System in India (TPDS). In 2010, 134 million people were provided with a food subsidy this number will double in 50 years if high fertility continues. On the other hand, if fertility declines, then 183 million people will require food subsidies in 2061, a difference of about 84 million people.

Technical Note:28% of Indias population is considered to be living below the poverty line (2004-05). 40% of Indias poor receive food subsidies (Economic Survey, 2008-9). Percent of poor people was multiplied by total population in a given year to arrive at the number of poor. The number of poor people was multiplied by the percent receiving subsidies to arrive at the number of poor people receiving subsidies.*If fertility were to decline, less people would require food subsidies. By 2061, the government would save over Rs 6,00,000 Crores from targeted public distribution alone. This is approximately equivalent to the Budget Estimate Revenue Receipts for the year 2010-2011 (Rs 6,18,833.60 Crores).

Technical Note:In 2007-08, the Ministry of Food and Distribution spent 44,590 Crore rupees. It is assumed that this amount was spent entirely on the targeted public distribution system (TPDS), i.e., food subsidy program. Source: The India Budget for 2009-2010.This number was used to calculate unit cost of public food distribution, amounting to 3,403 rupees.*Lets now consider population impact on the demand for water and electricity. Today, approximately 11 percent of Indias population is without access to safe drinking water. If high fertility continues, the number of people without access to safe drinking water will double in 50 years.

Technical Note: 89 percent of population has access to safe drinking water (UN Millennium Development Goals Indicators Database).It is assumed 11 percent of the population do not have access to safe drinking water.*Electricity is an issue in India, particularly in urban areas where load shedding is common. The per capita consumption of power in the country in 2005-06 as calculated by the Central Electricity Authority has been about 631 Kilowatt Hours. This information was given by Union Power Minister Shri Sushilkumar Shinde (August 2007). If we assume that the amount of electricity consumption remains constant over the next 50 years, by 2061, India will consume over 1.5 trillion Kw under the high fertility scenario. On the other hand, under the low fertility scenario, far less would be consumed.

If the per capita consumption was increased to 1,000 units by 2012 and held constant through 2061, India would need to produce 2.4 trillion kilowatt hours to meet consumption demand under the high fertility scenario (1.7 trillion kilowatt hours under low fertility scenario).

Technical Note: The National Electricity Policy envisages that the per capita availability of electricity will be increased to over 1000 units by 2012. The per capita consumption of power in the country in 2005-06 as calculated by the Central Electricity Authority has been about 631 Kilowatt Hours. This information was given by Union Power Minister Shri Sushilkumar Shinde in the Rajya Sabha today. **Let us look at the impact of fertility and population growth on the economy, our fourth development factor.The Eleventh Five-Year Plan has established several ambitious targets for improving Indias economy and increasing overall growth, namely:Maintaining an average GDP growth rate of 9% per yearReducing unemployment among the educated to less than 5%Increasing the real wage rate of unskilled workers by 20%Reducing the head-count ratio of consumption poverty by 10%.

An increase in Indias population would exacerbate several labour and development problems that the country faces, among others. Presently, over eight percent of Indias population is unemployed (SOURCE); moreover, both unskilled and skilled/educated workers are unable to find jobs. A lack of adequate opportunities for employment in rural areas has led to mass migration into cities, consequently adding additional pressures to urban infrastructure and resources through overpopulation. **If rapid population growth continues, the demand for jobs will more than double in the next 50 years, increasing the pressure on an already overloaded urban infrastructure.

Lower population growth can result in greater resources available for social sectors and development. At the individual level, there can be greater disposable income available for spending on education and health. With people productively employed, there is less likelihood of social unrest and instability.**Finally, let us look at the impact of population on our last development factor, health. India has a goal to improve access to and quality of healthcare for its citizens. Among its main objectives, the Five Year Plan and MDGs call for reducing maternal and infant mortality as well as reducing the fertility rate to replacement level.While there has been a decrease in the maternal mortality ratio (MMR) (from 301 maternal deaths per 100,000 live births in 2002 to 254 maternal deaths in 2004), much progress still needs to be made if India is to meet the MMR goal of 100 deaths per 100,000 live births by 2012. *In order to meet the MDG target of decreasing maternal deaths, states need to further invest in high-quality health care services and continue to support efforts to empower women to demand their reproductive health rights.

*This slide shows state-specific infant mortality rate. Every state has made progress in recent years; however, we can see that many states still need to make significant improvements.*Women and children are populations that require special attention, particularly when it comes to health and other social services. If high fertility rates continue, the number of women and children that the government would need to reach with these services is dramatically higher compared with a low fertility scenario (approximately 770 million versus 450 million).

*With lower population growth, fewer nurses and health facilities would be needed to meet the needs of the population, resulting in significant cost savings. Under this low fertility scenario, more resources would be available to improve health facilities and services. The available resources could also be used to recruit and train additional nurses and improve the provider-client ratio.

Technical note: It is assumed that the population per nurse ratio remains is 676 people per nurse in 2001 and decreases to 550 by 2020 and remains constant at this ratio until 2061. *A decrease in population also implies additional savings for health services; if fertility were to decline to replacement level, as projected, then India could potentially save over Rs. 5,00,000 Crores in cumulative health expenditures by 2061.

Technical note: It is assumed that the annual health expenditure per person is USD $4.0 in 2001 and increases to $6.7 in 2010 and increases to $7.2 by 2012 and remains constant until 2061 (SRS, RGI 2004).

The cost savings achieved in the health sector would mean more available resources to train, recruit and retain health providers. Greater investment in health providers and facilities will improve access to high-quality health services and in turn, contribute to better health outcomes.

**In summary, the previous section showed how population growth affects development sectors. That section was based on population projections assuming high and low fertility scenarios. Now we shall discuss the role of family planning in achieving population and development objectives. We shall also examine some challenges to achieving the identified development goals and objectives. The following sections are based on current national survey data and statistics.This slide shows the percent of married women and their use of family planning. As this slide shows, 46 percent of married women are not using any method of contraception, while seven percent of married women are using traditional methods.

Among modern method users (47%), sterilization is the most widely used method, i.e. 72 percent of modern method users. This skewed method mix implies a gap in service delivery (counseling and availability of a wide range of methods).

Technical Note:Family planning for currently married women who are 15 44. In Bihar, more than 50% of women are either sterilized or have an intra-uterine copper device (IUCD) inserted after their fourth child. In a situation where unmet need for spacing and limiting methods is high (37.2 percent of married women), this illustrates the need for timely and comprehensive counselling and availability of a wide range of methods for both spacing and limiting.*Here we see the percentage of married women who want to space their next birth for at least two years or limit future births (i.e. unmet need). This highlights that many of the northern states have substantial unmet need. More than one-third of women in UP, Jharkhand ad Bihar want to use contraception but are not currently using it quite high not only for India but also compared with many developing countries of the world.

Technical Note:DEFINITION OF UNMET NEED: Women who say either that they do not want any more children or that they want to wait two or more years before having another child, but in both cases are not using contraception, are considered to have an unmet need for family planning. Women who are using family planning methods are said to have a met need for family planning.

*By satisfying unmet need for family planning, India can speed its progress towards meeting its MDGs. For instance, nearly 12 lakhs infant deaths will have been averted from 2005 to 2015.

Technical Notes:Assuming unmet need will be satisfied by 2021, and the MDG goal of reducing infant mortality from 1990 to 2015 by two-thirds.*As discussed before, India has made strides in reducing maternal mortality; nevertheless, just by satisfying unmet need for family planning, an 35 thousand maternal deaths will be averted from 2010 to 2015.

Technical Notes:Assumes unmet need will be satisfied by 2021, and maternal deaths will be reduced by three-fourths from 1990 (540 deaths per 100,000 live births) to 2015 (135 deaths per 100,000 live births).*In addition to these lives saved, satisfying unmet need can alleviate pressure on social sector costs. The cost of meeting unmet need would total Rs 3,782 Crores while the total cost savings for four of the eight MDGs would total Rs 27,765 Crores from 2010 to 2015. This is a benefit-cost ratio of 7 to 1.

Technical Note: Immunization just for measles. Education use World Bank Indicators for unit costs for primary students. We have demonstrated how a focus on family planning and meeting unmet need can affect fertility and thereby help India meet population and development goals. Let us look at some of the challenges, in particular:Early marriage for teenage girlsLow female education ratesEarly and long periods of fertility (lack of birth spacing and high birth order)

*The percentage of women married before age 18, which is the legal age of marriage in India, is high and varies across states. Women who are married at a young age are often unable to finish their schooling or seek higher education. In India, women are often expected to begin childbearing as soon as they are married. A woman who begins childbearing when she is younger than 18 years of age puts herself and her infant at increased risk of complications during the pregnancy and during delivery. In India, nearly a quarter of the women (24%) who are 18 years old are pregnant or have already had a child.As we see, pregnancy rates vary substantially across levels of education. Thirty-three percent of women with no education are pregnant teenagers or pregnant mothers. In contrast, 4% of women with 12 or more years of education are pregnant teenagers or pregnant mothers. Not only are too many of our young girls married and pregnant, they are also missing out on an education. This slide shows that least seven in 10 rural women in high fertility states have less than 10 years of education. In contrast, in Himanchal Pradesh and Keralastates that have already reached replacement-level fertilityfewer than three in 10 rural women have less than 10 years of education.*Early and long periods of fertility also affect maternal and child health by exposing mother and child to complications related to high-risk births. This graph shows the age-specific fertility rates for three states (Jharkhand, Andhra Pradesh, and Tamil Nadu). Taking Jharkhand as an example in comparison to southern states, fertility starts early and continues at high rates throughout their reproductive years.*Delaying child and teenage marriages, promoting birth spacing, and encouraging fewer births per woman all help to reduce maternal and child mortality by eliminating the potential for high-risk births. The first set of bars show how the infant mortality rate is correlated to a mothers age. As we see, infant mortality rates are highest among mothers who are either less than 20 years or older than 40 years of age.

The second set of bar shows the relationship between infant mortality rate and birth order. Recognizing the relatively high risk of first pregnancies, particularly among young mothers, infant mortality rates are highest among women who give birth to 4 or more children.

As we have mentioned before, the third set of bars shows how important it is for us to support mothers to space their children by at least two years.

*Given the importance of family planning to population and development and the challenges faced, we now look at the role of policy in creating opportunities which promote family planning and satisfy unmet need, thereby bringing India one step closer to achieving its national goals.Despite the challenges we have discussed, we need to recognize that India is in a position to move forward. A number of favorable opportunities for FP/RH exist.

We have good policies in place. Leaders at the highest levels support family planning initiatives. Under NRHM, financial resources for health and family planning are not a constraint. Demand is there.

Elected officials, parliamentarians, policymakers, and state-level health directors play a critical role in recognizing and supporting this favorable momentum for FP/RH.*Several national policies recognize the role of FP/RH in meeting Indias health and developmental goals, namely:

Vision 2020Eleventh Five Year Plan (2007-12)Joint Review Mission on RCHNational Health PolicyNational Population Policy Millennium Development Goals

*Decision-makers play a key role in: implementing policy, supporting leadership, utilizing and allocating resources for health services, and meeting the demand for FP/RH. In doing so, India can achieve its target of replacement level fertility as well as helping families meet their desired family size.*Support for this presentation was provided by the USAID | Health Policy Initiative, Task Order 1.*

outline

Documents

population division10

population projections

populationindias population

population stabilization

projected population

world population prospects

world population millionsyear

revision population