Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized TUE WORLD BANK DETERMINANTS OF FERTILITY DECLINE IN INDIA March 1984 Population, Health and Nutrition Department PUN Technical inotes RES 11 * This paper is one of a series issued by the Population * * IHealth and Nutrition Department for the information and * * guidance of Bank staff working in these sectors. The * * views and opinions expressed in this paper do not neces- * * sarily reflect those of the Bank. *
A B S T R A C T Indian fertility has declined by at least 25 p-rcent in the last 20 years. The current fertility level is a TFR of 4.8, which is lower than that in any other country at the same or lower level ol soci'o-economic development. Since 1975 however, the birth rate has shown a tendency to stall. This is partly due to an emerging unfavounable age-structure (increase in the proportion of women in child-bearing ages) and partly due to stagnation in the family planning acceptance rate. Nearly 90 percent of the fertility decline could be accounted for by the increase in family planning practice, and the balance by increase in age at marriage. In spite of its dominant role in fertility decline, family planning input variables were less important than socio-economic factors. About 60 percent of the interstate variation in family planning practice (and hence fertility decline) could be attributed to socio-economic differences, 10 percent to differences in family planning inputs, and the remaining 30 percent to their interaction. Our interpretation of the extent, pattern and socio-economic correlates of fertility decline in India is that in the changing socio-economic situation, the increase in the cost of bringing up children creates a situation in which a smaller family size is becoming an economic necessity to an increasing number of couples. The family planning program served not only this emerging demand for small families, but created additional v:mand for contraception through information and incentives. Prepared by: K. C. Zachariah, PHNPR Sulekha Patel, PHNPR March 1984
Table of Contents Page No. T. Introduction... 1 II. Determinants of Fertility Decline - A General Framework 2... 2 III. Fertility Trend in incdia by States... 1. 4 IV. Proximate Determinants of Fertility... 15 - Age at M4arriage and Pruportion M4arried... 15 - Family Planning Program... 18 V. Socio-Economic Factors Related Fertility Decline... 27 VI. Summary and Conclusions... 39 Statistical Annex... 51
List of Figures Page No. Figure 1 Crude Birth Rate, India 1971-1980... 5 Figure 2 Demographic Transitions, c. 1960-1980, India and Indonesia... 14 List of Maps Map 1 Total Fertility Rate by States, 178... 12
List of Tables Page No. Table 1 Bir:ih Rates and Total Fertility Rates, India, 1941-51 to 1981... 6 Table 2 Birth Rates by States... 7 Table 3 Total Fertility Rates... 8 Table 4 Table 5 Ranks of States by Fertility Rate around 1980... 10 Ranks of States with Respect to Measures of Fertility Decline... 10 Table 6 Mean Age at M4arriage of Females... 16 Table 7 Proportion Married (Females) by Age, India... 17 Table 8 Table 9 Table 10 Table 11 Table 12 Table 13 Table 14 Table 15 Fertility Impact of Changes in Proportion Married, 1961-71 and 1971-81... 19 Birth Rates According to SRS and Estimated Birth Rates on the Basis of Births Averted due to Family Planning Program 1971-72 to 1982-83... 20 Percent of Couples Effectively Protected, India, 1970-71 to 1981-82... 20 Cumulative Sterili-zation, IUD Acceptance Rate and Percent of Couples Effectively Protected... 22 Decline in the Birth Rate, Actual, and Estimated on the Basis of Percent of Couples Effectively Protected...... 23 Fertility Impact of Official Family Planning Program, 1961-71 and 1971-81... 24 Family Planning and Nuptiality Factors in Fertility Decline... 25 Distribution of Family Planning Acceptors by Age of Wife and Method, 1973-74 and 1980-81... 26
- iv - List of Tables Page No. Table 16 Table 17 Table 18 Table 19 Table 20 Table 21 Table 22 Table 23 Average Age and Average Number of Living Children of Family Planning Acceptors... 26 Percent of Eligible Couples Effectively Protekcted in Rural and Urban Areas by State by Method, 1980-81... 28 Regression Analysis, Program Variables and Socio-economic Variables... 31 Total Marital Fertility Rate by Educational Attainment of Mothers... 32 Age Specific Marital Fertility by Education, 1978... 33 Age Specific Marital Fertility by Level of Education and Urban-Rural Residence, 1972... 33 Partial Regression Coefficients of Selected Fertility Related Variables on Years of Schooling (Wife), Kerala... 35 Regression between Children Ever-born and Education, Punjab... 36
DETERMINANTS OF FERTILITY DECLINE IN INDIA I. Introduction The Indian birth rate is now around 34 per 1,000 population and the TFR is about 4.8.1/ Prior to 1950 the birth rate was about 45 and the TFR was about 6.5. Thus India has definitely experienced a fairly significant fertility decline in recent years. Recent data show that the decline in the birth rate is not continuing as fast as it did in the past; the rate has stalled somewhat'at a level of about 34. Although such a stalling has been observed in a fewi other developing countries in recent years, it was not expected on the basis of historical experience of developed countries. In the past, at a level of 34, a birth rate usually declined rapidly. For example, international data on birth rates for the 1950's and: 1960's show that there were few countries with birth rates in the range of 30-34; most of the national birth rates were either above 35 or below 25.2/ The Indian birth rate is in this range, and therefore, it should have been declining more rapiuly. Yet the decline is slow; the rate appears to have stalled. There appear to be some basic differences between the factors which moderated fertility in the 1950's and earlier, and those which seem to be operating in India and in some of the other developing countries at present. What are the factors which caused the Indian fertility to decrease in recent years? In what ways do the determinants of the recent fertility decline in India differ from those of other countries in earlier times? This paper is concerned mainly with these questions. The paper begins with a general framework for explaining fertility trend in India. Inasmuch as this framework was developed largely on the basis of the work done by the author on determinants of fertility decline in Kerala,3/ this section gives a brief description of the Kerala framework of fertitity decline and its relevance in the Indian context. The paper later proceeds to a description of fertility levels and trends by states in India, and relates the Indian experience in fertility decline with the world experience. This is followed by an analysis of the role of the family planning program and increase in age at marriage in the decline in fertility. The last section takes up the interstate variation and socio-economic differentials in fertility and family planning practices and examines the factors related to their differences in a multivariate context. The paper ends with a summary and conclusions. 1/ Th- official estimate of 4.5 for 1978 is biased because of the higher representation of unmarried women in the sample. 2/ UN Population Bulletin No. 7, 1963. Table 1.2, p. 2 3/ K. C. Zachariah. Anomaly of the Fertility Decline in Kerala, PHN Technical Notes, RES2, Population, Health and Nutrition Dept., World Bank, July 1983.
-2- II. Determinants of Fertility Decline - A General Frame.uork In a recent reappraisal of theories of fertility decline, Ronald Freedman 4 / has suggested that for less developed countries today, motivation for fertility decline can arise from fewer changes than those that characterized the WZest. Under modern conditions, ideas and aspiration for a different way of life are also important in motivating lower fertility. The concept and means of family limitation within marriage produce an independent effect on fertility decline, once motivation is present. The author's analysis of fertility decline in Kerala suiggests that the concept and means of family planning have independent effects on fertility decline not only when motivation is present, but also when the motivation is weak or even absent. Official intervention in population matters is a relatively new phenomenon. This har altered somewhat the pattern of fertility decline and its relationship with socio-economic factors. In evaluating the determinants of fertility decline in India, it is necessary to take into consideration not only the socio-economic factors which are involved in demographic transition, but also this new element of official involvement and financial incentive for family planning practice. Emperical support for such a reappraisal of the demographic transition theory is given by the-kerala study. Kerala Framework of Fertility Decline5/ Kerala has experienced an unexpectedly rapid decline in fertility under seemingly unfavorable circumstances--low per capita income, low degree of urbanization, industrialization, etc. At the same time, the population is well-developed with respect to education and mortality decline, two very important factors in the classical transition theory. The theoretical framework assumed to explain fertility decline in Kerala includes not only these elements from the transition theory but also the new element of the influence of state policies and programs on fertility. The fertility decline in Kerala is a result of historical developments as well as recent policy interventions. Historical developments over the past 100 years have eroded the economic value of inherited characteristics (caste, religion, etc.) and inherited wealth (land), and enhanced the economic value of personal characteristics (education and health). Fueled by inter-communal rivalry in developing human capital, the State experienced a sharp decline in mortality and an accelerated improvement in educational attainment. Mortality has declined so much that 90 percent of children born today survive to adulthood, and education has improved so much that nearly all women in the childbearing ages are literate. The low mortality conditions and high educational attainment provide the necessary milieu for a 4/ Ronald Freedman. "Theories of Fertility Decline: A Reappraisal", Social Forces, 58(1):1-17, 1979. 5/ For an elaboration of the Kerala framework of fertility decline, see Zachariah, op.cit., pp. 230-243.
-3- fertility decline. The low mortality enables couples to attain their desired (surviving) family size with fewer children ever-born. The high educational attainment enables parents to make rational decisions about family size, taking into consideration mortality risks and their given socio-economic perspective; it has enabled couples to utilize family planning services effectively and limit or postpone births as and when they feel desirable; it has increased the cost of bringing up children as education has become a necessity for economic survival, and moreover, educated parents tend to give an even better education to their children; it has increased the opportunity costs of women and reduced the economic benefits from children; and it has increased the risk of utnemployment especially at critical younger ages. While these long-term socio-aconomic changes produced the necessary milieu and caused the age at marriage to increase, the sharp decline in marital fertility was precipitated by more recent policy interventions--land reforms, agrarian reforms, and the official family planning program ia particular. The land reforms and other redistributive policies operated on fertility in different ways. The economic realignment has caused some socio-economic groups to suffer loss of land, status, income, etc., with no hope of immediate recovery, forcing them to make demographic adjustments toward later marriages and fewer children. The increase in wages has decreased the income of land owners, even those who have not lost any land, forcing them also to adopt fertility control. Wage increases have boosted the cash income of female daily wage earners, raising the opportunity cost of their time spent in bringing up children. The increase in wages also has reduced employment opportunities, forcing children out of the job market and making them economically less valuable. Even the hutment dwellers who undoubtedly gained by the land reforms and wage legislation began to feel the need for birth control, as their children have found it impossible to obtain a place for a ilut of their own. The official family planning program came at an opportune time to serve the manifest demand, strengthen the latent demand, and create new demand for birth control, especially among the poor. Applicability of Kerala Framework to other States of India The socio-economic situation in the other states is somewhat different from that in Kerala, and yet we feel that the fertility decline in these other states can also be explained in the same general framework, namely; - increase in cost of briniging up children in relation to the benefits from them, and - family planning education and services. In Kerala, the cost increase came about because of increase in the proportion of children surviving in a family, the economic necessity to invest in children's education and health, and through a series of policies related to land distribution, wages, etc. These changes are relevant in the other states also, but the degree of change and their relative
-4- importance vary significantly from state to stateg It is our hypothesis that interstate variation in the extent of fertility change in recent years can be explained by the differences in the family planning program and in the changes in the socio-economic factors which determines the cost of bringing up children in these states. The principal among these socio-economic factors are mortality, education, agricultural density, female wages, and land redistribution. III. Fertility Trend in India by States Fertility Trend in India. There is some uncertainty about the fertility level and trend in India. Recent data are more reliable and they indicate that the birth rate is about 34 and the total fertility rate is about 4.8. Working backwards on the basis of expected decline due to family planning program and changes in proportion married, an estimate of 6.5 can be taken as the TFR for India as a whole before 1960. These figures indicate a fertility decline of 26 percent in recent years. Substantial declines took place before and after 1971. Rough estimates are: a decline of 0.8 in TFR before 1971 (12%) and a decline of 0.9 during 1971-81 (16%). Since 1976 the decline in birth rate has slowed dowai. In fact, birth rate seems to have stalled (Table 1 and Figure I), although the fertility rate continues to decline, but at a slower rate. An approximate decomposition of the decline in birth rate during 1961-71 and 1971-81 is given below: Factors 1961-71 1971-81 1961-81 1. Total decline: 4.0 (100)1/ 6.0 (100)1/ 10.0 (100)1/ 2. Due to age-sex compositional change: 2.14 (54) - 1.13 (-19) 1.01 (10) 3. Due to changes in marital status composition: 0.61 (15) 0.76 (+13) 1.37 (14) 4. (2) and (3) together: 2.75 (69) - 0.37 (-6) 2.38 (24) 5. Due to fertility reduction within marriage: 1.25 (31) 6.40 (106) 7.64 (76) 1/ 4 = 44-40; 6 = 40-34; 10 = 44-34. It shows that during 1961-81, the birth rate declined by about 10 points. Nearly three-fourths of this decline was due to declines in marital fertility. The age-sex composition contributed 10 percent to the decline and marital status composition 14 percent. Thus the three factors reinforced each other.
-5- Figure I: Crude Birth Rate, India 1971-1980 C B R 40.... -------------- - Ii --- 2-- 3-74 75 76-77 _-----7, 8 7J
- 6" Table 1. Birth Rates and Total Fertility Rates, India, 1941-51 to 1981 Birth Rate TFR Period Reported Correctedc/ Reported Correcteda/ 1941-51 39.9 43.0 1951-61 40.9 44.0 1961-71 41.1 41.1 1970 36.8 1971 36.9 40.0 1972 36.9 38.6 5.17 1973 34.6 37.4-5.75 1974 34.5 36.4 4.88 1975 35.2 35.5-1976 34.4 34.9 4.68 1979 33.7 34.1 1977 33.0 34.4-1978 33.3 34.1 4.50-4.90 1980 33.7 34.1 1981 33.9-4. 8 0 b/ Sources: Reported-:. 1941-51 to 1961-71. Census of India estimates (reproduced from Visaria p. 10); 1970-1978 Sample Registrationi data (from Visaria p. 19 and 1979-81 from Sample Registration Bulletin XVI, (2) December 1982, p. 34. a/ "Preliminary Estimates of Fertility Decline in India during the 1970's," A.K. Jain and A.L. Adlakha. b/ World Bank estimate. C/ SRS Bulletin, June 1983. This was however not the case in the most recent decade. In 1971-81 changes.in age-sex distribution was highly unfavorable to a decline in birth rate (i.e., the proportion women in child bearing ages increased). Had there been no change in marital status distribution and marital fertility, the birth rate would have increased by 1.1 points because of the age-structure effect. On the other hand, -in the earlier period, 1961-71, changes in age-sex composition were highly favorable to a decline in the birth rate. Had there been no change in the marital status and marital fertility the birth rate would still have declined by 2.1 points. The shift in the direction between 1961-71 and 1971-81 is very instructive. It shows that 1971-81 could be the beginning of a longer period in which increasing proportion of women in child bearing ages would tend to dampen the decline in the birth rate or make it increase even when fertility falls. The "age effect" has to be much stronger towards the end of the decade than in the beginning (evident from the change in the sign). This is one explanation of the stalling of the Indian birth rate since 1976. There could, of course be other explanations also.
-7- Fertility Trend by States The States are very heterogeneous with respect to levels and trends in the birth rate. Table 2 indicates that in five of the major states, the crude birth rate was below 30. These states are inhabited by 190 million people, more than the population of Indonesia. Such a significanit decline among such a large population is worth noting while comparing the Indian family planning program with other countries in Asia. U. Table 2. Birth Rates by States Crude Birth Rate per 1,000 Population States Census SPS 1951-61 1961-71 1970-72 1979-81 Andra Pradesh 39.7 39.2 35.4 31.5 Assam 49.3 48.4 37.9 32.7 Bihar 43.4 41.9 40.9a/ 38.4 Gujarat 45.7 41.6 40.4 35.1 Haryana 44.2a/ 44.5 39.6 36.8 Jammu and Kashmir 42.2a/ 41.5 32.5 31.3 Karnataka 41.6 39.9 32.0 28.2 Kerala 38.9 37.5 31.3 26.2 Madhya Pradesh 43.2 46.6 39.2 37.4 Maharashtra 41.2 41.0 32.0 28.3 Orissa 40.4 41.3 35.8 31.8 Punjab 44.7 36.9 34.2 29.6 Rajasthan 42.7 42.7 41.1 36.8 Tamil Nadu 34.9 36.8 31.3 28.2 Uttar Pradesh 41.5 42.5 44.5 39.5 West Bengal 42.9 44.3 36.6a/ 31.5 India 41.7 41.2 37.2 33.2 a/ Estimated by author. Sources: 1951-61 and 1961-71: Economic Situation and Prospects in India. World Bank Report No. 3872 IN. 1970-72: Family Welfare Programme in India Yearbook, 1981-82, Government of India, New Delhi, Table B.5. 1979-81: Sample Registration Bulletin, Vol. XVI, tio. 2, Dec. 1982. Ten years ago there was no state in India with a birth rate below 30, and twenty years ago there was none with a birth rate below 35.
-8- In comparison to these relatively successful states are several other states, six among the major ones, with a combined population of 314 million and a birth rate above 35 even in 1982. These states have also experienced some decline in the birth rate, but the effect of the family planning program was not large enough to make a major impact on the birth rate. Table 3. Total Fertility Rates Urban Rural Combined States* 1972 1978 1972 1978 1972 1978 Andra Pradesh 4.5 2.7 4.8 4.1 4.7 3.8 Assam 3.7 2.8 5.3 4.0 5.2 3.9 Bihar 3.9 3.4 5.1 4.2 5.0 4.1 Gujarat 4.5 3.6 6.0 4.6 5.6 4.3 Haryana 4.7 3.2 7.0 4.6 6.6 4.3 Jammu and Kashmir 3.1 2.8 5.2 4.8 4.8 4.4 Karnataka 3.5 3.0 4.5 3.7 4.3 3.5 Kerala 3.6 2.3 4.2 2.8 4.1 2.7 Madhya Pradesh 4.4 3.8 6.2 5.3 5.9 5.0 Maharashtra 3.8 2.9 4.8 3.9 4.5 3.5 Orissa 4.0 3.5 4.7 4.3 4.6 4.2 Punjab 4.1 3.2 5.7 4.1 5.3 3.9 Rajasthan 5.4 3.9 6.4 5.5 6.2 5.2 Tamil Nadu 3.0 2.9 4.4 3.5 4.0 3.3 Uttar Pradesh 4.8 4.1 6.9 5.9 6A6 5.6 West Bengal 3. 6 a/ 2.5 4. 5 a/ 3.5 4. 3 a/ 3.2 * States with a population of 5 million or more in 1981. a! Estimated by the author. Source: Vital Statistics Division, Office of the Registrar General. Levels, Trends and Differentials in Fertility, 1979. Ministry of Home Affairs, New Delhi, November 1981. Table 3 above gives the reported fertility rates by states in 1972 and 1978 for urban and rural areas separately. These rates are not very accurate, but can be used for comparative purposes. 6! The heterogeneity shown by the birth rate is also evident in the fertility rate, both in the urban and rural areas. There are a few other sources of fertility data for inter-state comparison. These are from the 1971 and 1981 census. The principal sources are child-women ratio (children 5-9 years/women 20-49 years) and average number of children ever-born. On the basis of all these we intend 6/ Some of these rates are clearly underestimates although the number of births used in the calculations are fairly accurate. The total marital fertility rates (TMFRs) are more reliable.
-9- to make an assessment of the relative rank of the various states with respect to (i) fertility level around 1980 and (ii) fertility decline during 1970-80. Table 4 gives the ranks of the states by.the fertility indices. The various souarces are not entirely consistent, but the average ranks are likely to give the best comparison. These are given below in Column A. A comparison of fertility declines according to available measures is given in Table 5. The independent sources are not entirely consistent, but the inter-state patterns shown by the SRS data (1972 and 1978 and the child-women ratio (1971 and 1981 for the group 5-9 years) are remarkably close. On that basis we get the ranks of the states given under Column B. Column A Fertility level from lowest to the highest Column B Fertility Decline from highest to lowest 1. Kerala 1. Kerala 2. Tamil Nadu 2. Punjab 3. Maharashtra 3. West Bengal 4. Punjab 4. Gujarat 5. Andhra Pradesh 5. Maharashtra 6. Karnataka 6. Karnataka 7. West Bengal 7. Tamil Nadu 8. Gujarat 8. Andhra Pradesh 9. Orissa 9. Orissa 10. Bihar 10. Madhya Pradesh 11. Madhya Pradesh 11. Rajastan 12. Rajasthan 12. Bihar 13. Uttar Pradesh 13. Uttar Pradesh
- 10 - Table 4. Ranks of States (lowest fertility equal to 1) by Fertility Rate around 1980 CWRC/ Average No. of B.R.a/ TFRb/ 1981 Children Ever- States 1979-81 197W (5-9 yrs.) Born (30-34) 1. Kerala 1 1 1 1 2. Punjab 5 7 3 6 3. West Bengal 6.5 2 7 9 4. Gujarat 9, 10 5 7 5. Maharashtra 4 4.5 4 4 6. Karnataka 2.5 4.5 8 9 7. Tamil Nadu 2.5 3 2 2 8. Andhra Pradesh 6.5 6 6 3 9. Orissa 8 9 9 8 10. Madhya Pradesh 11 11 10 12 11. Rajasthan 10 12 13 13 12. Bihar 12 8 11 5 13. Uttar Pradesh 13 13 12 11 a/ Birth Rate b/ Total Fertility Rate c/ Child-Woman Ratio Table 5. Ranks of the States with Respect to Measures of Fertility Decline States (1) (2) (3) (4) Andhra Pradesh 6 7 10 7.7 Bihar 8 12 12 10.7 Gujarat 4 3 4 3.7 Karnataka 7 2 7 5.3 Kerala 1 5 1 2.3 Madhya Pradesh 11 9 8 9.3 Maharashtra 5 1 5 3.7 Orissa 13 6 9 9.3 Punjab 2 5 2 3.0 Rajasthan 10 10 11 10.3 Tamil Nadu 9.8 6 7.7 Uttar Pradesh 12 13 13 12.7 West Bengal 3 4 3 3.3 (1) Using SRS total fertility rates in 1972 and 1978. (2) Based on estimated decline due to FP and marital status change. (3) GCange in child (5-9 years) - woman ratio. (4) Average of cols. (1) through (3).
Geographic Patterns: Fertility rates and birth rates are lower in the southern States of India than in the northern States. In the north, the central States have in general higher fertility rates than those in the eas. or west (See Map 1). Assuming that fertility rates were not very much different in the past, the relatively lower rates in the south must imply a relatively more rapid fertility decline in these states. The path of fertility decline in India seems to follow the path of the south-west monsoon. The monsoon reaches India first in Kerala and then spreads northwards. On the way, it splits into two, covering northwest and northeast before reaching the north central states, namely Uttar Pradesh, Bihar, Madhya Pradesh and Rajasthan. These states are yet to experience a good shower of fertility decline. Indian Fertility in the International Context Is a birth rate of 34 or a TFR of 4.8 too high, too low, or just average for a population like India's? In one respect, this is a very low level. When its development indicators are taken into consideration, there is no other country in the world with a fertility rate lower than India's (see Figures A1 and A2 in the Annex). For example, at the level of income per capita in India, the expected TFR is 5.8, but the rate for India is 4.8. Similarly, for its literacy rate, the expected TFR is 6.6, and for its IMR the expected TFR is 6.1. Thus, with respect to each one of these socio-economic indicators, the Indian fertility rate is lower than expected on the basis of international or less developed country experience. Not only that, at these levels of development, no other country has a lower fertility rate. For example, there is no country with an IMR higher than India's but fertility rate lower than India's. Similarly there is no country with a female literacy rate lower than India's, but with lower TFR. Thus, the Indian fertility rate is relatively low when its developmental indicators are taken into consideration. But this is hardly comforting for the Indian planners. The Indian population growth rate is too high from the point of the country's developmental needs. Fertility Trend in India and Indonesia One interesting comparison of Indian fertility trend is with the Indonesian rates. As is shown in Figure II, demographic transitions in India and Indonesia are practically indistinguishable. Fertility and mortality decline in Indonesia are no higher than those in India during the period 1960-80, yet the family planning program in Indonesia is considered to be a "success" while that in India is referred to as a "failure." Ia this connection the following observation by McNicoll and Singarimbun 7 / is worth quoting: 7/ Fertility Decline in Indonesia. Analyses and Interpretation Committee on Population and Demography. Report No. 20. National Academy Press, Washington, D.C., 1983, p. 112.
-12 - Total Fertility Rate by States, 1978 14.1 I N D I A - ; A.Sh'4JL#' * 'Jlre *n'd Stnr' IIoAItItOy ctp,iitril t t Jar- *i'. * '-.-.. *-Q >th.r Clle, e i'*o ac-to'...,t iae nn 1*a Jnon r^.-to,y Bo-,d-its -Y 5I' \ F48.~ ~ sg.,,i nternatoo-l 8ound-ries PAKISTAN C 4 1;< ; /,..s.; / CH-N ~ 4,. p -JS -- i ;- NEPAL A- f *U ru 4 ' ~ V?ANGLADESHJ~ 4. s 'qa' A. i~j. r! 11~ 751r 4I X I. 1 X o /J'rn4;sIr. * I1 Hyd,,wabo, A- RA 1-ES1I ' b4rig1 ' 'S' _. I'gr :,'z 8t*.^ u e r iri ANKA TFR below. 4,40. K TFR between 4.O and 5,0 TFR above 5,.0
- 13 - It is a curious reflection on the capriciousness (or short attention span) of the international population community that, although Indonesia's demographic transition has roughly paralleled India's over the last two decades (with East Java's present fertility on a par with Kerala's or Tamil Nadu's), Indonesia is hailed as a population policy success story while India is typically portrayed as a failure. The demograpaiic similarity may well extend to the bases for some of the regional fertility differentials: the likelihood that most other Indonesian provinces will soon reach East Java's present fertility level may be no greater than that of the northern states of India soon reaching Kerala's. The fact that the Indian fertility is not too high when its socio-economic development is taken into consideration, or that the Indian fertility decline has been as fast as that of Indonesia, which is hailed as a success story with respect to its family planning program, do not minimize the grave implications of the high fertility rate in India. The fertility rate and the consequent rate of population growth are too high from the point of the country's developmental needs. The Indian population is growing at an unprecedentee 16 million per year, higher than in any other country in the world, including China. The Indian rate of population growth has not declined a bit even after 30 years of family planning: the growth rate in 1971-81 was the same as that in 1961-71. The demographic targets set by the Indian planners have rarely been reached or even approached. The births in 1984 would be 6.3 million more than the target (based on an actual rate of 34 and a target of 25 set in 1973). The built-in momentum for population growth in India is such that even if the impossible target of a replacement level fertility is reached in 1984, the Indian population will grow by 80 percent.' In reality, it is extremely difficult to contain the annual growth in India's population to under 16 million per year through the remaining years of the century. Thus, although the Indian fertility rate is not too high by international standards, and is lower than that in any other country of comparable socio-economic development, yet, because of the large base population, high population density, and the need to develop fast from its low level of development,'the fertility rates in most states of India are much too high and the need to accelerate the decline in the birth rate is very urgent. For this purpose, we need to know what factors have caused the fertility to fall in India, what are the reasons why the birth rate has begun to stall, and what are the policy options at the disposal of the planners to accelerate fertility decline. The remaining sections of.he paper are concerned with these questions.
- 14-25-, Death Rate 1960 20" Figure II Demographic Transitions, c. 1960-1980 India and Indonesia India 15 Indonesia 1980 10 50 45 40 35 30 25 20 15 10 Birth Rate Source: Fertility Decline in Indonesia, Analysis-anddITterptetation Committee on Population and Demography. Report No. 20, National Academy Press, Washington, D.C. 1983. Figure 1, page 7.
- 15 IV. Proximate Determinants of Fertility The principal proximate determinants of fertility are: a. proportion married; b. proportion using contraception; c. rate of induced abortion; and d. length of lactation infecundity period. Although all four are important, we will take up only two of them, namely, proportion married and proportion protected by contraception. Very little reliable information i-s available on the trend in either the number of induced abortions or the length of lactation ammenorrhea. In any case, their net effect on fertility change is not likely to be very large, as they are in the opposite directions. Age at Marriage and Proportion Married Age at marriage of females has been relatively very low in most states of India and one of the reasons for the high fertility in the country is that by the time a woman becomes old enough to recognize the problems of a large family, she already has too many children; there is little she can do at that stage. The mean age at marriage of females in 1961, 1971 and 1981 is given in Table 6. The singulate mean age at marriage for females was 18.7 years in 1981 and 17.8 years in 1971, representing an increase of nearly one year in the 10-year period. Similar increases took place in the previous decade. Thus, the age at marriage in India is increasing, but very slowly. Proportion Married For fertility trend, what matters most is the proportion of women married in each age group. These proportions change not only due to change in age at marriage, but also due to change in the age at which marriages are dissolved. Proportions married among females in 1961, 1971 and 1981 are given in Table 7. The proportion of married women decreases at younger ages, 15-19 years and 20-24 years, as a result of the increase in age at marriage. At the 1972 fertility rates, these decreases in proportion married should result in a decrease in TFR by 0.198 between 1961 and 1971, by 0.143 between 1971 and 1981 and by 0.341 between 1961 and 1981. This decrease was partly compensated by increases in proportion married at older ages which is a reflection of the increase in the age at marriage dissolution, especially through widowhood. The effect of this increase was an increase in the TFR by 0.119 during 1961-71, 0.047 during 1971-81 and 0.166 during 1961-81. The net effect of changes in age at marriage formation and marriage dissolution was a decrease in TFR of 0.079 during 1961-71, a decrease of 0.097 during 1971-81 and 0.176 during 1961-81. Thus, although increase in age at marriage has been a factor in the fertility decline in India in recent years, part of the effect of increase in age at marriage was nullified by the simultaneous increase in the age at widowhood leaving only a relatively small net decrease in fertility due to marital factors.
-16 - Table 6: Mean Age at M4arriage of Females SMAMa/ States 1961 1971 19/1 1981 Andra Pradesh 15.4 16.4 16.2 17.3 Assam 18.6 18.5 - - Bihar 14.7 15.5 15.3 16.5 Gujarat 17.2 18.3 18.4 19.5 Haryana 15.8b/ 17. 5 b/ 16.6 17.9 Jammu and Kashmir 16.1 17.8 - - larnataka 16.5 17.9 17.8 19.2 Kerala 20.1 20.9 21.0 21.9 Madhya Pradesh 14.3 15.2 15.0 16.5 Maharashtra 15.9 17.5 17.5 18.8 Orissa 16.5 17.2 17.3 19.0 Punjab 17.6 18.8 20.2 21.0 Ra1-sthan 14.6 15.4 15.1 16.1 Tamil Nadu 18.4 19.6 19.6 20.2 Uttar Pradesh 14.8 15.6 15.5 17.8 West Bengal 16.1 17.8 17.9 19.3 a/ Singulate Mean Age at Marriage b/ For Himachal Pradesh Sources: R.P. Goyal. "Shifts in Age at Marriage in India between 1961 and 1971", Demography India, Vol. 4 No. 2, Dec. 1975. SMAM, 1971 and 1981: Census of India, Paper 2 of 1983, Table 8.
- 17 - Table 7. Proportion Married (Females) by Age, India Age Census Fertility 1961 1971 1981 1972 15-19 69.6 55.4 43.5 213 20-24 91.8 88.8 88.4 313 25-29 94.2 95.0 94.3 299 30-34 91.4 94.1 94.8 239 35-39 87.0 91.3 93,2 161 40-44 77.7 84.2 87.8 86 45-49 69.7 78.0 82.9 29 Source: India Census Reports, 1961, 1971 and 1981. 1972: Vital Statistics Division, Office of the Registrar General. Levels, Trends and Differentials in Fertility, 1979. Ministry of Home Affairs, New Delhi, Nov. 1981.
18 - Results of the calculations done at the state level is given in Table 8. The highest impact was in Eunjab where the TFR had declined by 0.295 during 1961-71 and 0.207 during 1971-81 due to marriage factor alone. On the other hand, there are a number of other states, where the effect is very negligible. Family Planning Program The history and development of the family planning program in India is too well-known to be repeated here. This section will be concerned with only the impact of the program on fertility trends. The Indian Family Welfare Program has an excellent evaluation program which collects and publishes service statistics. They include: i) family planning acceptors by methods; ii) cumulative acceptance of family planning by methods since the inception of the program; iii) couples currently and effectively protected by the various family planning methods; and iv) number of births averted. These statistics (primary and derived) are found to be quite accurate as ascertained by independent sample surveys in the various states by research organizations and by the Operations Research Group (ORG) at the national level. Selected family planning statistics for India and for the states are given in the Annex Tables Al to A7. Cumulative Achievement Since the inception of the program, 36.2 million sterilizations were performed (21.8 million vasectomies and 14.4 tubectomies); 9.5 million IUD's were inserted and a large number of condoms and pills were distributed. It is estimated that as a result of this program, 49.3 million births were averted and currently 24% of the eligible couples are effectively protected. An analysis done by the Director of Evaluation (Government of India).concluded that the births averted by the program could account for all the decline in the birth rates. If the pre-program birth rate was about 45.0, the estimated rate in 1981-82 on the basis of the births averted by the program would be 34.9 (1981-82); if the pre-program rate was only 42.5, the 1982-83 rate would be 32.8. The SRS rate for that year was 33.2. Thus, the program could account for almost the entire decline in the birth rate (Table 9). In 1971-72, the proportion of couples effectively protected was 12.4 (Table 10). The fertility impact of such protection in terms of birth rate was a reduction to a level of about 38.4 (Table 9). The effect on TFK was a reduction of 0.79 of a child per woman (Table 13). By 1981-82 the proportion of couples protected increased to 23.7. The additional reduction in the birth rate during 1971-81 due to family planning program was 3.5 points. The effect on TFR was 0.8 of a child per woman (Table 13).
- 19 - Table 8. Fertility Impact of Changes in Proportion Married,. 1961-71 and 1971-81 Expected Change in TFRl/ Percent Decline TFTR States -l61-/-1 I911-8J 1961-71 1971-81 Andra Pradesh +.001 -.115 +0.02-1.98 Assam -.012 - -0.22 - Bihar +.077 -.112 +1.28-2.00 Gujarat -.166 -.187-2.86-3.32 Haryana - - - - Jammu and Kashmir -.133 - -2.25 - Karnataka -.106 -.238-1.87-4.29 Kerala -.122 -.111-2.56-2.39 Madhya Pradesh +.031 -.182 +0.51-2.96 Maharashtra -.105 -.190-1.81-3.34 Orissa +.061 -.326 +1.06-5.60 Punjab -.295* -.207-5.21-3.86 Rajasthan +.022 -.112 +0.36-1.81 Tamil Nadu -.128 -.093-2.39-1.78 Uttar Pradesh -.029 -.121-0.47-1.97 West Bengal -.191 -.229-3.38-4.20 India -.080 -.098-1.38-1.71 1/ Keeping constant marital fertility and using observed proportion married. * Adjusted for areal changes between 1961 and 1971. The following fertility rates were used: 213, 313, 299, 239, 161, 86, 29. Source: World Bank Computations.
- 20 - Table 9. Birth Rates According to SRS and Estimated Birth Rates on the Basis of Births Averted dug to Family Planning Program 1971-72 to 1982-83 Estimated Birth Rate Year SRS if the Rates before the Program were: 42.3 45.0 1971-72 36.9 36.1 38.4 1972-73 36.6 35.4 37.b 1973-74 34.6 34.6 36.8.1974-75 34.5 34.5 36.7 1975-76 35.2 34.4 36.6 1976-77 34.4 33.6 35.7 1977-78 33.0 32.2 34.3 1978-79 33.3 32.6 34.7 1979-80 33.1 32.7 34.8 1980-81 33.3 32.8 34.9 1981-82 33.2 32.8 34.9 1982-83 -- 32.5 34.6 Source: Family Welfare Program in Inidia Year Book 1981-82, Government of India, New Delhi p. 8 Table 10. Percent of Couples Effectively Protectedi India, 1970-71 to 1981-82 Year Sterilization IUD CC Users Total 1970-71 8.1 1.4 1.1 10.6 1971-72 9.9 1.3 1.2 12.4 1972-73 12.3 1.1 1.2 14.7 1973-74 12.4 1.0 1.5 14.9 1974-75 12.8 1.0 1.2 15.0 1975-76 14.4 1.1 1.7 17.1 1976-77 20.9 1.1 1.8 23.7 1977-78 20.2 0.9 1.5 22.6 1978-79 19.9 0.9 1.6 22.4 1979-80 19.9 1.0 1.4 22.3 1980-81 20.0 1.0 1.7 22.7 1981-82 20.7 1.1 2.0 23.7 Source: Family Welfare Programme in India. Yearbook, 1981-82. Government of India, New Delhi, p. 107.
- 21 - We have seen that the fertility effect of increase in age at marriage during 1971-81 was about 0.1. Thus, a rough estimate of the relative contribution of family planning in the fertility decline during 1971-81 would be 89%; the other 11% can be attributable to changes in proportion married. Interstate Variation As could be expected from the interstate variation in fertilityrates, family planning performance varies considerbly from state to state (Table 11). By far the best performance was in Maharashtra where both the cumulative sterilization rate (492 per 1,000 married women aged 15-44) and percent of couples protected were the highest (37%). At the other extreme is Uttar Pradesh with a cumulative sterilization rate of only 128 per 1,000 married women aged 15->44 and a protection rate of 11%. The state-wise impact of the program on birth rate and TFR was not readily available in published reports. An approximate estimate was obtained using the regression relation between percent of couples protected in a year (in India) and the corresponding expected program birth rate. The results are shown in Table 12. In some states the observed decline in the birth rate was close to that estimated on the basis of couples protected (e.g. Kerala, Maharashtra) while in others they are very much different, (e.g., Assam). The disagreement between the two sets need not be due to errors in estimated births averted or in percent of couples protected. It can as well arise from errors in the birth rate, especially the rate in the earlier of the two years. This is likely to be the main reason for the large difference in Assam. The effect of family planning program performance on TFR was calculated using constant marital fertility by age group and decreasing the number of married women in each age group by the number of women protected by family planning methods. The results are given in Table 13. The highest impact was in Gujarat, Maharashtra, and Haryana. In these states the TFR declined by more than 2 children per woman during 1961-81 or by more than 40 percent. Next in order comes Kerala, Andhra Pradesh, Punjab and Karnataka. Fertility decline due to family planning was least in Uttar Pradesh, Jammu and Kashmir and Bihar. On the whole fertility decline since 1971 was slightly higher than that before 1971. This was true in all states except Haryana, and Jammu and Kashmir. Table 14 gives the combined effect of contraceptive practicte andchanges in marital status distribution. It also gives the contribution of family planning to the combined total. In 1971-81, the fertility contribution of family planning varied from 89 percent in Andhra Pradesh and Tamil Nadu to 65 percent in Punjab. Between the two periods 1961-71 and 1971-81, the percent contributed by family planning has declined in most states. This was not due to an absolute decline, but more due to a relatively larger increase in the contribution of the nuptiality factor.
- 22 - Table 11. 'Cumulative Sterilization, IUD AcceptaTce Rate, and Percent of Couples Effectively Protected Cumulative Steriliza- Cumulative IUD Intion Rate per 1,000 sertion per 1,000 % of Couples State Married Women 15-44 in Married Women Effectively 1981 (Up to March '81) 15-44 in 1981 Protected Rate Rank Rate Rank Rate Rank Andhra Pradesh 359.4 6 33.2 17 27.2 7 Assam 239.1 13 67.5 10 18.3 13 Bihar 166.8 15 33.4 16 12.2 15 Gujarat 407.8 3 75.6 9 34.9 2 Haryana 311.7 8 283.1 2 28.6 4 Himachal Pradesh 297.8 9 113.2 3 26.0 9 Jammu and Kashmir 138.0 16 93.4 7 10.8.17 Karnataka 289.6 11 86.1 8 24.7 10 Kerala 414.0 2 109.7 4 32.0 3 Madhya Pradesh 331.0 7 61.3 11 21.8 12 Maharashtra 491.6 1 48.1 14 36.7 1 Orissa 374.9 5 99.9 5 26.1 8 Punjab 273.1 12 305.6 1 27.4 6 Rajasthan 168.7 14 47.5 15 14.5 14 Tamil Nadu 404.1 4 53.4 12 27.7 5 Uttar Pradesh 128.0 17 97.8 6 11.3 16 West Bengal 294.8 10 52.7 13 24.4 11 India 297.9 78.2 23.7 Source: Family Welfare Programme in India. Yearbook 1981-82. Government of India, New Delhi, pp. 84-85, 108. Some of the rates were recalculated using 1981 census data on married women 15-44 years.
- 23 - Table 12. Decline in the Birth Rate, Actual and Estimated on the Basis Percent of Couples Effectively Protected Decline in Birth Rate Between 1951-61 and 1979-81 States Expected from % Difference of Couples Effec- (Actual- Actuall/ tively Protected 2 / Expected) Andhra Pradesh 8.2 10.9-2.7 Assa'm 16.6 8.6 +8.0 Bihar 5.0 7.0-2.0 Gujarat 10.6 12.9-2.3 Haryana 7.4 11.2-3.8 Jammu and Kashmir 10.9 6.6 +4.3 Karnataka 13.4 10.2 +3.2 Kerala 12.7 12.1 +0.6 Madhya Pradesh 5.8 9.5-3.7 Maharashtra 12.9 13.3-0.4 Orissa 8.6 10.6-2.0 Punjab 15.1 10.9 +4.2 Rajasthan 5.9 7.6-1.7 Tamil Nadu 6.7 11.0-4.3 Uttar Pradesh 2.0 6.7-4.7 West Bengal 11.4 10.1 +1.3 1/ From Table 2. 2/ Estimated using the regression 3.8 + 0.26 (percent effectively protected in 1980). The coefficients are estimated from the time-series for India as a whole (Tables 9 and 10).
- 24 - Table 13. Fertility Impact of Official Family Planning Program - 1961-71 and 1971-81 Decline in TFR Percent Decline TFR States 1961-71 1971-81 1961-71 1971-81 Andhra Pradesh 0.867 0.946 14.9 19.1 Assam 0.368 0.767 6.7 15.1 Bihar 0.396 0.458 6.5 8.0 Gujarat 1.091.1.234 19.4 27.2 Haryana 1.272 0.862 21.0 17.7 Jammu and Kashmir 0.488 0.224 8.4 4.2 Karnataka 0.581 1.002 10.5 20.6 Kerala 0.981 0.882 21.1 24.1 Madhya Pradesh 0.671 0.847 10.9 15.5 Maharashtra 1.125 1.180 19.8 25.9 Orissa 1.013 0.719 17.4 14.9 Punjab 1.416 0.391 26.4 9.9 Rajasthan 0.387 0.650 6.3 11.2 Tamil Nadu 0.882 0.789 16.8 18.2 Uttar Pradesh 0.417 0.387 6.8 6.8 West Bengal 0.556 0.979 10.2 20.U INDIA 0.79 0.80 13.8 16.2 Note: Using constant age specific martial fertility, 1971 proportion married, 1971 and 1981 proportion of women protected, and 1981 age distribution of the protected women. Source: World Bank computations
- 25 - Table 14. Family Planning and Nuptiality Factors in Fertility Decline 1961-71 1971-81 Fertility Decline Fertility Decline States Total Due to F.P.(%) Total Due to F.P.(%) Andhra Pradesh.866 100 1.061 89 Ass-am.380 97 - - Bihar.319 124.570 80 Gajarat 1.257 87 1.421 87 Jammu and Kashmir.621 79 - - Karnataka.687 85 1.240 81 Kerala 1.103 89.993 89 Madhya Pradesh.640 105 1.029 82 Maharashtra 1.230 91 1.370 86 Orissa.952 106 1.045 69 Punjab 1.711 83.598 65 Rajastan.365 106.762 85 Tamil Nadu 1.010 87.882 89 Uttar Pradesh.446 93.508 76 Wiest Bengal.747 74 1.208 81 Source: World Bank computations. Characteristics of Family Planning Acceptors The effectiveness of family planning practice depends not only on the number of persons who practice, but also on the characteristics of the acceptors, especially their age distribution and parity. The majority of the family planning acceptors are in their thirties; nearly a third are in the age group 30-34 years. More than 80% of the acceptors are in the age group 25-39 years. The average age of acceptors was 31.6 in 1973-74 but decreased to 30.5 by 1980-81. Thus, over the years, the average age has decreased somewhat, indicating that the fertility impact of family planning acceptance has increased. By the time an average Indian woman reaches 30 to 35 years, she already has produced most of her children. The average number of living children at the time of acceptance was more than 3.5 for acceptors of sterilization. This is the average desired number of children as expressed by women in most of the surveys conducted in India in recent years. Thus when couples in India accept terminal methods of family planning they have achieved or surpassed their desired family size.
- 26 - Table 15. Distribution of Family Planning Acceptors by Age of Wife and Method, 1973-74 and 1980-81 Age Vasectomy Tubectomy IUD All Combined 73-74 80-81 73-74 80-81 73-74 80-81 73-74 80-81 15-19 1.6 0.3 0.2 0.5 2.9 4.4 1.4 1.0 20-25 10.6 10.5 7.0 12.7 18.0 28.4 11.2 13.6 25-29 21.2 29.4 30.5 36.2 30.8 34.0 27.7 33.8 30-34 30.9 33.0 36.3 32.0 29.6 21.7 32.7 31.6 35-39 22.6 20.1 20.7 15.4 14.5 9.3 19.5 15.9 40-44 11.8 6.4 5.1 3.2 3.6 2.2 6.7 3.8 45-49 1.3 0.3 0.3 0.1 0.6 0.0.8 0.3 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Avg. Age 32.7 31.6 31.4 30.4 29.4 28.0 31.6 30.5 Source: Family Welfare Programme in India. Yearbook, 1981-82 Government of India, New Delhi, p. 119. Table 16. Average Age and Average Number of Living Children of Family Planning Acceptors Avg. Age (Years) Avg. No. of Living Children Year - Vasectomy Tubectomy IUD Vasectomy Tubectomy IUD 1973-74 32.7 31.4 29.4 74-75 32.8 31.8 29.8 75-76 32.8 31.8 29.3 76-77 33.1 31.2 28.8 77-78 32.5 30.1 28.1 3.1 3.5 2.6 78-79 32.4 30.4 28.3 3.4 3.7 2.8 79-80 31.9 30.4 28.2 3.5 3.7 2.7 80-81 31.6 30.4 28.0 3.5 3.7 2.6 Source: Family Welfare Programme in India. Yearbook, 1981-82. Government of India, New Delhi, pp. 119, 123
- 27 - V. Socio-Economic Factors Related to Fertility Decline The previous section has shown that much of the fertility decline in India in recent years (as much as 80% in 1971-81) was due to the increased contraceptive practice. States which have shown a high acceptance rate have experienced high fertility decline also. As a result, the factors underlying fertilty decline in India are to a large extent the factors which determine contraceptive practice. In this section, therefore, we begin with an analysis of the factors related to the interstate differences in family planning practice. Family Planning Family planning acceptance rate varies considerably by socio-economic factors. It is higher in the urban areas than in the rural areas, higher among the Hindus than among the Muslims, etc. The urban-rural difference is evident from Table 17 which gives the percentage of eligible couples effectively protected in urban and rural areas of each state. The percentage of couples protected in the urban areas is higher than that in the rural areas in all states. The ratio (U/R) varies from 3.8 in Kerala (for sterilization) to 1.0 in the Punjab. Multivariate Analysis Factors related to family planning use are analysed in a multivariate context using two measures of family planning performance. They are: i. percent of couples effectively protected, 1981-82 ii. cumulative equivalent sterilization up to 1982 per 1000 population A simple regression between percent of couples effectively protected in 1981-82 and program variables indicated that expenditure on family welfare in 1981 can explain 32 percent of the variance. Other input variables are highly correlated with expenditure and did not add much to the total variance explained. Dependent variable: percent couples effectively protected in 1981-82 Independent Variables B F Ratio R2 1. Expenditure on F.W. (1980-81) per capita +.636 6.4 32.1 2. Field workers (1981-82) per capita -.418 0.4 2.0 TOTAL 34.1 When socio-economic variables alone were used in the regression, the total explained variance was to 74.0 percent. The variables which had statistically significant association are: