Fam­i­lies get smaller in size as more chil­dren are saved

Bet­ter nutri­tion, vac­ci­na­tion and health­care en­sure cou­ples lose fewer chil­dren to mal­nu­tri­tion and in­fec­tions

Hindustan Times (Jalandhar) - - HT INSIGHT - San­chita Sharma sa­chi­tasharma@htlive.com n

NEW DELHI: In­dia’s most com­pre­hen­sive re­port card on health re­leased ear­lier this year shows In­dia’s to­tal fer­til­ity rate (TFR) has dropped from an av­er­age of 2.7 chil­dren per women in 2006 to 2.2 a decade later. Around two in three states that are home to half the coun­try’s pop­u­la­tion are well be­low the “re­place­ment” TFR – the de­sired fam­ily size when the pop­u­la­tion stops grow­ing – of 2.1 chil­dren per woman, shows coun­try­wide data from the Na­tional Fam­ily Health Sur­vey-4.

The coun­try’s av­er­age fam­ily size is be­ing pushed up by seven of In­dia’s most pop­u­lous states, where TFR re­mains above 2.1. Bi­har, Ut­tar Pradesh and Jhark­hand are the lag­gards, with fam­ily sizes higher than 2.5. But even there, the de­cline in pop­u­la­tion growth has been im­pres­sive. Ut­tar Pradesh has shown the high­est de­cline in TFR (1.1%), fol­lowed by Na­ga­land (1%), Arunachal and Sikkim (0.9%), shows NFHS-4 data.

The boom may be over, but the growth will con­tinue. In­dia is home to the world’s largest youth pop­u­la­tion, with 40% of its pop­u­la­tion un­der the age of 20 years (Cen­sus 2011). This will push its 1.3 bil­lion pop­u­la­tion to over­take China’s by 2024 to make In­dia the world’s most pop­u­lous nation. “For In­dia, 75% of pop­u­la­tion growth in the The role com­ing decade will be due to mo­men­tum from In­dia’s large youth pop­u­la­tion that is in or about to en­ter child­bear­ing age,” said Diego Pala­cios, coun­try rep­re­sen­ta­tive, UNFPA In­dia.

“Pop­u­la­tion growth is slowed by de­lay­ing mar­riage, de­lay­ing first birth, in­creas­ing space be­tween chil­dren and pro­vid­ing qual­ity fam­ily-plan­ning ser­vices, which must be done in con­ju­ga­tion with schemes that em­power women and en­able them to de­lay mar­riage and child­birth,” said Pala­cios.

Fam­i­lies will con­tinue to shrink as more peo­ple get ac­cess to con­tra­cep­tives and bet­ter nutri­tion, vac­ci­na­tion and health­care to pre­vent new­born and child deaths from mal­nu­tri­tion and in­fec­tions like sep­sis, di­ar­rhoea and pneu­mo­nia.

CASEBOOK FAM­ILY

It’s hap­pen­ing, but in fits and bursts. Rama Ahir­wai’s life is a study in how most states achieved pop­u­la­tion sta­bil­i­sa­tion. Rama, 29, lives in a two-room house with her hus­band Kam­lesh, mother-in-law Ramkail, sis­ter-in-law An­jali and sons Umang and an un­named new­born boy in vil­lage Baroh in the Ganj Ba­soda block of Mad­hya Pradesh’s Vidisha dis­trict. Kam­lesh cuts stone in a nearby quarry, and makes enough to get food for his fam­ily and al­co­hol for him­self. He has lit­tle time, money or in­cli­na­tion to worry about the health of his fam­ily of five.

Though Rama is among the three in four (75.4%) women in In­dia who doesn’t earn and is de­pen­dent on her hus­band for money, she has more say in house­hold de­ci­sions than women did a decade ago. Pri­mary school­ing has taught her lit­tle more than the al­pha­bet and writ­ing her name, but she’s smart enough to know she can­not de­pend on her hus­band for sup­port in child­birth and rear­ing her chil­dren. “He’s out all day and has no time for the chil­dren. He says it’s not his job, so I do it bet­ter than he would,” she said.

So Rama does the best she can for her fam­ily. She’s en­sured both her chil­dren were de­liv­ered free at a gov­ern­ment health cen­tre in neigh­bour­ing Pathari health cen­tre by avail­ing of all the ma­ter­nity health ben­e­fits given un­der the Janani Shishu Su­rak­sha Karyakram. The scheme pro­vides free and cash­less de­liv­ery at a health cen­tre, free medicines and di­ag­nos­tics, free food dur­ing hos­pi­tal stay and free trans­port to hos­pi­tal and back.

Ramkali is dis­mis­sive of the fuss, but doesn’t grudge Rama get­ting the at­ten­tion. “Ev­ery­one de­liv­ers in a hos­pi­tal these days, when I had my five chil­dren, no one did,” said Ra­makali. “...In our day, we had more chil­dren be­cause we would lose half to fate.”

Only three of Ramkali’s five chil­dren – two girls and Kam­lesh, 30 – are alive. Pooja got mar­ried at 18 seven years ago but the youngest An­jali, 22, doesn’t plan to marry soon. “I walk 5 km one way with a friend to study at Ag­ni­hotri Col­lege in Pathari, where I’m do­ing Arts (Bach­e­lor’s, sec­ond year). It’s tough but I re­ally want to be­come a teacher. I don’t want mar­riage or chil­dren now,” said An­jali. or health cen­tre. This makes the qual­ity of care and ad­vice on con­tra­cep­tives, child­hood vac­ci­na­tion and nutri­tion at the hos­pi­tal or health cen­tre crit­i­cal for the mother and new­born’s health. This doesn’t al­ways hap­pen.

Rama didn’t get in­for­ma­tion on con­tra­cep­tion or spac­ing. Her chil­dren were born 18 months apart when the ideal gap be­tween two births is three years. She is breast­feed­ing her baby, but has got no nutri­tion ad­vice at the hos­pi­tal or the Asha worker. Chalk mark­ings on her wall show an ANM has vis­ited her home to re­view the health of her new­born and tod­dler un­der the state gov­ern­ment’s on­go­ing month-long Das­tak Ab­hyan to check mal­nu­tri­tion. But it’s just a mark on the wall, no one has re­viewed the chil­dren’s weight, height and health. “Didi wrote on the wall and went away, but did not come in­side...,” said An­jali.

The chal­lenge, as al­ways, is track­ing and re­view­ing the providers. “Mo­ti­vated ASHAs (com­mu­nity health work­ers) can change the health of their com­mu­nity so both she and the com­mu­nity gain. We had an Asha who earned ~21,000 a month as in­cen­tives for en­sur­ing ev­ery­one used all avail­able ser­vices,” said Dr B B Sharma, block med­i­cal of­fi­cer in Ich­hawar in Se­hore dis­trict of Mad­hya Pradesh. If ev­ery­one works as well, In­dia’s pop­u­la­tion growth will stop grow­ing sooner than later.

Rama Ahir­wai (right) with her sons – 10­day­old un­named one and 18­month­old Umang, mother­in­law Ramkali (left) and sis­ter­in­law An­jali (stand­ing), at their two­room home in Baroh vil­lage in Vidisha, Mad­hya Pradesh. MUJEEB FARUQUI/HT

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