Human beings evolved under conditions of high mortality due to famines, accidents, illnesses, infections and war and therefore the relatively high fertility rates were essential for species survival. In spite of the relatively high fertility rates it took all the time from evolution of mankind to the middle of the 19th century for the global population to reach one billion. The twentieth century witnessed an unprecedented rapid improvement in health care technologies and access to health care all over the world; as a result there was a steep fall in the mortality and steep increase in longevity. The population realized these changes and took steps to reduce their fertility but the decline in fertility was not so steep. As a result the global population has undergone a manifold increase in a hundred years and has reached 7 billion.

World Population

World population grew to 7.06 billion in mid-2012 after having passed the 7 billion mark in 2011. Developing countries accounted for 97 percent of this growth because of the dual effects of high birth rates and young populations.

Conversely, in the developed countries the annual number of births barely exceeds deaths because of low birth rates and much older populations. By 2025, it is likely that deaths will exceed births in the developed countries, the first time this will have happened in history.

Population Trends in Developing Countries

Africa. By far, the largest regional percentage increase in population by 2050 will be in Africa, whose population can be expected to at least double from 1.1 billion to about 2.3 billion. That projection, however, depends on the assumption that sub-Saharan Africa's total fertility rate (TFR, the average number of children per woman) will decline from 5.1 to approximately 3.0 by 2050. That decline, in turn, assumes that the use of family planning in the region will rise significantly. But recent surveys from many sub-Saharan African countries have indicated that TFR decline is either slower than projected or is not taking place at all. Only 20 percent

Asia. With a current population of 4.3 billion, Asia will likely experience a much smaller proportional increase than Africa but will still add about 1 billion people by 2050. Much of Asia's future population growth will be determined by what happens in China and India, two countries that account for about 60 percent of the region's population. In India, the largest unknowns are future fertility trends in the heavily populated northern states where TFRs of about 3.5 are well above those of India's southern states. Asia’s TFR is 2.2 (2.5 when the large statistical effect of China is removed). Excluding China, 47 percent of women in Asia use a modern form of con'raception. Within Asia, several of the more economically advanced countries such as Japan, Singapore, South Korea, and Taiwan have TFRs of 1.4 or even lower. In Japan, 24 percent of the population is already ages 65 and older, a proportion certain to continue growing. Thus far in Japan, government efforts to restore somewhat higher past levels of the TFR have not been successful.

Latin America. Latin America and the Caribbean is the developing region with the smallest proportional growth expected by 2050, from 599 million to 740 million, largely due to fertility declines in several of its largest countries such as Brazil and Mexico. The region's TFR is currently about 2.2 children per woman, and the use of modern contraception, at 67 percent, rivals that of developed countries

Population Trends in Developed Countries

The very sharp decline in fertility in the developed countries, and how long it has lasted, has been completely unforeseen. TFRs of 1.4, 1.3, and even lower, took demographers by surprise. Yet not all developed countries tell the same story. In countries such as France and Norway, social programs to support families—such as generous maternity leave and subsidies for child care—have kept TFRs close to 2.0.

Europe is likely to be the first region in history to see long-term population decline largely as a result of low fertility in Eastern Europe and Russia. Europe's population is projected to decrease from 740 million to 732 million by 2050. The population of the 27 countries in the European Union, around 502 million, should roughly maintain their current size, even with large increases in the elderly population compared with younger age groups. The recent global recession has dimmed hopes in many European countries on the prospects of raising low birth rates to mitigate the economic effects of unprecedented proportions of the elderly, such as shortages in pension systems and rising health care costs for the "old-old" (ages 85 and above). In Australia, Canada, New Zealand, and the United States, continued growth from higher births or continued immigration, or both, are expected, although these countries have not been immune to lower birth rates due to the recession. In the United States, for example, the TFR was 1.9 births per woman in 2010.

India’s Population

India, like many other countries, has come a long way from the initial days of evolution under conditions of high mortality due to famines, accidents , illness, infections and war, when relatively high levels of fertility was essential for species survival. Over the years , better equipped in dealing with diseases and vagaries of nature, it has witnessed significant increase in life expectancy along with steep fall in mortality .Confronted with Malthusian growth , changing social mores and spurred by government interventions , the population responded by taking steps to reduce fertility, but the continued increase in number of women in reproductive age has ensured high number of births each year. Consequently, in the world of seven billion people, India along with China already occupies a place in the Billionaire club and is likely to overtake China by 2025.

India in World Population

The three most populous ones, namely, China, India and USA, together account for four of every person of the world. At present, a little more than one out of every six person in the world is from India.

The gap between India, the country with the second largest population in the world and China, the country with the largest population in the world has narrowed from 238 million in 2001 to nearly 131 million in 2011. On the other hand, the gap between India and the United States of America, which has the third largest population, has now widened to about 902 million from 741 million in 2001. In 1950, China with 22 percent share of the world population was the world's most populous country, followed by India, which had a share of 14.2 percent. The population of India is almost equal to the combined population of U.S.A., Indonesia, Brazil, Pakistan, Bangladesh and Japan put together- the population of these six countries totals 1214.3 million! A point that is striking is that while India accounts for a meagre 2.4 percent of the world surface area of 135.79 million square kms, it supports and sustains a whopping 17.5 percent of the world population. In contrast, the USA accounts for 7.2 percent of the surface area with only 4.5 percent of the world population. As such, among the ten most populous countries of the world, only Bangladesh has a higher population density compared to India'.

The United Nations has estimated that the world population grew at an annual rate of 1.23 percent during 2000-2010. China registered a much lower annual growth rate of population (0.53 percent) during 2000-2010, as compared to India (1.64 percent during 2001-2011). In fact, the growth rate of China is now third lowest among the ten most populous countries, behind Russian Federation and Japan and it is substantially lower than the USA (0.7 percent). The average annual exponential growth rate for selected countries and the world is depicted in Figure 2. With a definite slowing down of population growth in China, it is now estimated that by 2030, India will most likely overtake China to become the most populous country on the earth with 17.9 percent population living here' . World population was transformed in the 20th century as technological and social changes brought steep declines in birth rates and death rates around the world. The century began with 1.6 billion people and ended with 6.1 billion, mainly because of unprecedented growth after 1960. The momentum created by this population growth may carry the world population far beyond 7 billion by 2015. It is almost certain that nearly all future population growth will occur in the developing regions of the world. Urban areas in these regions will absorb most of the additional people".

Data shows that the poor tend to have larger famalies. In the developing countries, a "youth bulge" ensures that the absolute number of births will rise even as couples are having fewer children. At the other extreme, most countries in Europe now have a "youth dearth" after decades of low fertility. Stagnant growth or even population decline is challenging more countries as fewer workers must support expanding pension and social security systems for their aging citizens. Governments have crafted a range of population policies to address these and other issues over the last half-century. In developing countries, policies include support for family planning and reproductive health programs and efforts to improve women's status, to enable women to have the number of children they want. In developed countries, particularly Japan and parts of Europe, Governments have implemented policies to promote gender equality in the workplace and ease the burden of childrearing all to encourage women to have more children. The factors that drive childbearing trends such as the economy, education, gender relations, and access to family planning are numerous and complex, and public policies and programs to influence population trends must address many issues at once. Demographic changes often take years to be evident, making it difficult to predict how today's actions will affect the future size and distribution of populations. Small changes in childbearing trends today have huge implications for future population size."

India: Size, Growth Rate & Structure

India has witnessed a population growth from 1028.7 million in 2001 to 1210.2 million in 2011. From 2001 to 2011 the increase in rural population is 90.5 million while for the urban population it is 91.0 million. In 2011, Uttar Pradesh has recorded the highest rural population at 155,111,022 while the lowest rural population is seen in Lakshadweep at 14,121. The urban population figures indicate that Maharashtra has the maximum urban population at 50,827,531 while the minimum is seen in Lakshadweep at 50,308.

The population of India, at the turn of the twentieth century, was only around 238.4 million. This has increased by more than four times in a period of one hundred and ten years to reach 1210 million in 2011. Interestingly, the population of India grew by one and half times in the first half of the twentieth century, while in the later half it recorded a phenomenal three-fold increase. Statement 2 presents the population of India as recorded in each decadal Census since 1901. Some other indicators of growth rate such as decadal growth rate, change in decadal growth, average annual exponential growth rate and progressive growth rate over 1901 during each decade have also been presented in this statement. Figure 3 shows the decadal growth of population for India during 1901-2011.

One of the important features of the present decade is that, 2001-2011 is the first decade (with the exception of 1911-1921) which has actually added lesser population compared to the previous decade. This implies that as a result of the combination of population momentum and somewhat impeded fertility, although India continues to grow in size, its pace of net addition is on the decrease. In absolute terms, the population of India has increased by about 181 million during the decade 2001-2011. Although, the net addition in population during each decade has increased consistently, the changes in net addition has shown a steady declining trend over the decades starting from 1961. While 27.9 million more people were added between the decade 1981-1991 than between 1971-1981, this number declined to 19.2 million for the decades between 1981-1991 and 1991-2001. The provisional results of 2011 shows that between 2001 and 2011, the net addition is less than that of the previous decade by 0.86 million.

POPULATION GROWTH RATES

It is significant that the percentage decadal growth during 2001-2011 has registered the sharpest decline since independence. It declined from 23. 87 percent for 1981-1991 to 21.54 percent for the period 1991-2001, a decrease of 2.33 percentage point. For 2001-2011, this decadal growth has become 17.64 percent, a further decrease of 3.90 percentage points. Similarly, the average exponential growth rate for 2001-2011 has declined to 1.64 percent per annum from 1.97 percent per annum during 1991-2001. The average annual exponential growth rate during 1981-1991 was 2.16. Figure 4 depicts the percentage decadal growth rate of independent India.

Structure

Sex Ratio

Density of population

Literacy

Age structure

Rural Urban distribution

POPULATION Distribution

Uttar Pradesh continues to be the most populous State in the country with almost 200 million people living here, which is more than the population of Brazil, the fifth most populous country in the world. The combined population of Uttar Pradesh and Maharashtra (the second most populous State), at 312 million, is substantially greater than the population of USA, the third most populous country of the world. Twenty States and Union Territories now have a population of over ten million. On the other extreme, there are five States and Union Territories in the country that are yet to reach the one million mark. Statement 3 and Figure 5 show the relative share of population of the States and Union Territories to the total population of India as per Census 2011. The statement also provides the ranking of these States and Union Territories by Population size in 2001 and 2011. While Uttar Pradesh (199.6 million), Maharashtra (112.4 million), Bihar (103.8 million), West Bengal (91.3 million) and Andhra Pradesh (84.7 million) have all held on to the top five slots in terms of their ranking in 2011 as compared to 2001, Madhya Pradesh (72.6 million), which has moved on to take the sixth position from its seventh position, pushing Tamil Nadu (72.1 million) now to the seventh spot. A little more than six of every ten Indians live in one of these seven States.

Impact of Population Growth 

India's population growth rate has been declining over the years but the overall population will continue to grow as 51% of the population is in the reproductive age group (15-49). Millions more will join this cohort each year. Every year, 26 million babies are born. Only 53% of the eligible couples are using contraceptives. At current levels, it may take several decades more to stabilise the population.

In India the levels of maternal and infant mortality are very high. Repeated childbirths are seen as an insurance against multiple infant and child deaths. Vast numbers of people cannot avail of services even when they are available, due to problems of knowledge and access.

India accounts for 2.4% of the world's surface area yet it supports 17.5% of the world's population. As the population grows, the pressure on natural resources will intensify. Population pressure will reduce the per capita availability of land for farming, which will affect availability of food grain, drinking water, besides excluding millions of people from the benefits of health and education and the opportunity to become productive members of society. More than half a billion Indians are less than 25 years of age.

In the states where the growth rates are high, maternal mortality and infant mortality is also very high. Repeated child births aggravate the health and survival risks to both mother and child. According to the International Institute for Population Sciences, 2006 in a study prepared for the Ministry of Health and Family Welfare and National Commission on Population, early pregnancies before the age of 20 increase maternal and child birth risks. The societal pressure for early child bearing and lack of spacing thereafter affects the mother's health and can lead to death of the infant or the birth of an underweight child. This sets in motion a vicious cycle of births, deaths and ill-health. It affects overall development. It is vitally necessary to make family planning services available where men and women can access them freely. IIPS's study indicates that in many states like Bihar, Jharkhand, Rajasthan, Uttar Pradesh and some North Eastern States several districts have a low couple protection rate of 40%. This is in contrast to the rest of the country where the couple protection rates are 52 to 62%. Unless young people adopt family planning methods and space families, population growth will pull back the development of the country.

Stabilising population is an essential requirement for promoting sustainable development. Making reproductive health care accessible is the foundation for stabilising population.

Some Facts

1.   51% of India's population is in the reproductive age-group.

2.   157 million more people will be added by 2016.

3.   About 42 percent of population increase is contributed by births beyond two children per family

4.   188 million couples require contraceptive coverage.

5.   Out of them only 53% are currently using contraceptives

Vast numbers of people cannot avail the services even when they are available due to problems of knowledge and access. Special efforts are needed to improve this particularly in underserved areas.

Stabilising population is an essential requirement for promoting sustainable development.

Making reproductive health care accessible is the foundation for stabilising population

What are the factors that influence population growth?

Natural increase denotes the difference between the number of births and deaths. The country has seen declining death rates but the birth rates remain high; birth rates are high due to two factors. The first is unwanted and unplanned fertility - children who are born because of lack of poor access to contraceptive services, also known as the "unmet need". The birth of three and above three children accounts for 45% of the 26 million births that take place each year.

Second is the desire for larger families (called "wanted fertility") because of socio-cultural reasons, particularly preference for a male child and high infant mortality. This accounts for 20% of births.

More significantly, the momentum brought in by the young age profile of the population spurs growth. This phenomenon will continue to add large numbers to India's population in the coming decades.

Population and associated Issues

Population And Sex Ratio

Sex ratio is an important parameter that reflects the status of women in society. Some of the worst gender ratios, indicating gross violation of women’s rights are found in south and East Asian countries such as India and China. In India sex-ratio is declining reaching upto 928:1000. But more important and serious thing is that with social, educational, economic development, it is declining. In 2011 Census it is seen that in all states except Bihar, Gujarat and Jammu Kashmir the sex ratio is increased, it is also increased in UTs except Dadra & Haveli and Daman & Diu. Female Mortality Rate is observed to be very low in most of parts of Northern India. But comparatively sex ratio is high in Southern States of India. Reasons for neglect of girl child and low levels of sex ratio are son preference, low status of women, social and financial security associated with sons, socio-cultural practices including dowry and violence against women. Small family norm may be a catalyst in the declining child sex ratio.

Population and Environment

The United Nations Conference on the Human Environment held in Stockholm in 1972 (United Nations, 1973) stated that the growth of population in certain areas, through both net migration and national increase, had accelerated the rates that could frustrate all the efforts to conquer poverty and underdevelopment and to maintain a safe and stable environment. The unprecedented consensus at the ICPD in 1994 squarely underscored the complex interrelationships between population, sustained economic growth, poverty and the environment. The programme of action stressed the need for integrating population and environment issues in planning and decision-making and for modifying unsustainable consumption and production patterns in order to foster sustainable resource use and prevent environmental degradation. It is also called for the implementation of policies to address the ecological implications of population dynamics. Rapid population growth and poverty in country is adversely affecting the environment. As the 21st century begins, growing number of people and rising levels of consumption per capita are depleting natural resources and degrading the environment. In India, the rapid increase of population combines with desperate poverty to deplete and pollute local resource bases on which the livelihood of present and future generations depends. Though the relationship is complex, population size and growth tend to expand and accelerate these human impacts on the environment. What is more concern, the number of population rise will increase to such an extent in future that it will cause overall scarcity for resources. India is having 18 percent of the world's population on 2.4 percent of its land area has great deal of pressure on its all natural resources.

Population and Food Security

The National Food Security Act, 2013 (also Right to Food Act) is an Act of the Parliament of India which aims to provide subsidized food grains to approximately two thirds of India's 1.2 billion people. Under the provisions of the bill, beneficiaries are to be able to purchase 5 kilograms per eligible person per month of cereals rice at INR3 (5.0¢ US) per kg, wheat at INR2 (3.4¢ US) per kg and coarse grains (millet) at INR1 (1.7¢ US) per kg. Prices. Pregnant women, lactating mothers, and certain categories of children are eligible for daily free meals. Every State will have to chalk out its own strategies for sustainable livelihood to move on the path of sustainable food production and sustainable livelihood security. This calls for sound policies and investments in natural resources such as land and water, flora and fauna, forests and biodiversity -- the ecological foundations essential for sustainable food security - plus sustainable intensification of crop and animal production. Population pressures and the forces of atmosphere and climate change must also be taken into account.Food security has three components. The first is food availability, which depends on food production and imports. The second is food access, which depends on purchasing power. The third, food absorption, is a function of safe drinking water, environmental hygiene, primary health care and education.

Population And Health Care

As per industry reports, healthcare is poised to grow at an estimated annual rate of 19 per cent to reach USD 280 billion by 2020 with India being recognized as a destination for world class healthcare. During the last decade the private sector grew to become the major provider of healthcare services. Its share of beds increased from 49 per cent in 2002 to 63 per cent in 2010. The Indian government has also introduced several reforms. The 11th and 12th Five Year Plans and international focus on the Millennium Development Goals have led to successes, especially in the primary health area – maternal and child health, and infectious diseases. The National Rural Health Mission has achieved efficiency and health system reforms, while the Rashtriya Swasthya Bima Yojana (RSBY) - a national social health insurance scheme - has aimed to cover in-patient treatment, possibly making quality healthcare and private sector facilities accessible to the poor. The All India Institutes of Medical Sciences (AIIMS) are a group of autonomous public medical colleges of higher education. Apart from AIIMS New Delhi, established in 1956, there are six AIIMS institute at Bhopal, Bhubaneshar, Jodhpur, Patna, Rishikesh and Raipur.

National Health Policy was formulated by Central Government in 2002. The social obligation for the government to ensure the highest possible health status of its population and as part of this, ensure that all people have access to quality health care has been recognized by a number of key policy documents. The policy directions of the Health for All declaration became stated policy of Government of India with the adoption of the National Health Policy Statement of 1983. Driven by this declaration there was some expansion of primary health care in the eighties. Further, the National Health Policy of 2002 and the Report of the Macro- Economic Commission on Health and Development (2005) were to emphasize a) the need to increase the total public health expenditure from 2 to 3% of the GDP, b) the need to strengthen the role of public sector in social protection against the rising costs of health care and the need to provide a comprehensive package of services without reducing the prioritization given to women and children’s health.

The National Rural Health Mission (NRHM) was launched on 12th April 2005 to provide accessible, affordable and quality health care to the rural population, especially the vulnerable groups. The National Urban Health Mission (NUHM) as a sub-mission of National Health Mission (NHM) will meet health needs of the urban population with the focus on urban poor, by making available to them essential primary health care services and reducing out of pocket expenses for treatment.

Population And Employment

As estimated by the World Bank, India is one of the few countries of the world where the working age population will be far in excess of those who will no longer be able to work. Unemployment records in India are kept by the Ministry of Labour and Employment of India. From 1983 till 2011, Unemployment rates in India averaged 7.6 percent reaching an all time high of 9.4 percent in December 2010 and a record low of 3.8 Percent in December 2011. In India, the unemployment rate measures the number of people actively looking for a job as a percentage of the labour force. The number of unemployed persons in India decreased to 39963 thousand in 2009 from 39974 thousand in 2007. Unemployed persons in India and kenya averaged 36933 thousand from 1985 until 2009, reaching an all time high of 41750 thousand in 2001 and a record low of 24861 thousand in 1985. In India, unemployed persons are individuals who are without a job and actively seeking to work. India has a Gini coefficient of 36.8. According to NSS(66th round) Report from Ministry of Statistics and Programme Implementation, Government of India published on 2013 Kerala has the highest unemployment rates and ranks worst, while Rajasthan and Gujarat has the least unemployment rate among major States of India. National average for unemployment rate stands at 50.

POPULATION AND SKILLED LABOUR

Beyond doubt, our youth power is one of the most important assets for economic development! India’s demographic dividend is a one-time window of opportunity that cannot afford to be missed; failing is not an option, for that would be a national disaster. Almost 40% of India’s workforce had received no formal training.  Thus, a large section of India’s population is virtually unemployable, or can function as unskilled workers. The other side of this situation is that the Indian industry is facing a shortage of skilled labour despite the bulge in workforce. This shortage is affecting the economy across both manufacturing and services sectors. For example it has been estimated that the Construction sector, on which almost 6% of the country’s workforce depends for livelihood, is facing a 30% percent labour shortage. Rough back of the hand calculations indicate that addressing the skill gap shortage in Construction alone could add USD 20 billion to the Indian economy. In order to tackle the situation steps like skilling of the new entrants to the workforce,   upskilling of workers for higher or new skills and recognizing informal ‘on the job’ training of existing workers are need of the hour. The last is especially important given over 92% of India’s labour market is unorganized.

POPULATION AND POVERTY ALLEVIATION

The Government recognises that high growth of incomes is by itself not enough to improve the quality of life of the poor. Unless all the citizens of the country, and most particularly the poor, have certain basic minimum services, their living conditions cannot improve. These minimum services include among other things literacy education, primary health care, safe drinking water and nutritional security. The Government had convened a meeting of Chief Ministers to identify such basic minimum services and a list of seven services had unanimously been agreed upon. These seven services are safe drinking water, primary health facilities, universal primary education, nutrition to school and pre- school children, shelter for the poor, road connectivity for all villages and habitations, and the Public Distribution System (PDS) with a focus on the poor. The Ninth Plan lays special emphasis on these seven basic minimum services and will make all efforts to achieve a minimum level of satisfaction in providing these in partnership with the State Governments and the Panchayati Raj Institutions (PRIs). The Integrated Rural Development Programme (IRDP) aims at providing self-employment to the rural poor through acquisition of productive assets or appropriate skills which would generate additional income on a sustained basis to enable them to cross the poverty line. Other programmes like National Old Age Pension Scheme (NOAPS), National family Benefit Scheme (NFBS), National Maternity Benefit Scheme, Annapurna, Integrated Rural Development programme, Rural Housing-Indira Awaas Yojana (IAY)(initiated in 1985),  Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA) were also initiated to control poverty in India.

The introduction of high-yielding varieties of seeds and the increased use of chemical fertilizers and irrigation are known collectively as the Green Revolution, which provided the increase in production needed to make India self-sufficient in food grains, thus improving agriculture in India.

POVERTY LINE DETERMINATION

One in three Indians lives below the poverty line according to the Tendulkar Committee report which used a measurement of goods and services, rather than calorie intake, to calculate poverty. A new method to draw the ‘poverty   line’ has resulted in an increase in the number of people living below   the poverty line in India, from 27.5% of the population to 37.2%, that   is, an increase of 10% for 2004-05.  A committee headed by economist   Suresh Tendulkar has drawn up a new formula for assessing poverty, which   it has submitted to the Planning Commission. The Dandekar-Rath poverty  line formula that has been used since 1971 measures only the calorie   content of an Indian’s diet. If it is lower than 2250 calories per   person per day, the person is declared to be under the poverty line.  This norm was not revised in 35 years. The Tendulkar Committee replaces   the calorie measurement by a cost-of-living index, that is, how much   money a person spends. It looks at a basket of household goods and services   such as health and education. The new poverty line is different   for different states and also different for rural and urban areas within   a state. The all-India average rural  poverty line is set at a monthly expenditure of Rs 446.68 a month; the   national urban poverty line at Rs 578.8 a month. Goa’s rural poverty   line is the highest, pegged at Rs 608.76 a month; Delhi’s is Rs 541. The Ministry of Health and Family Welfare, in collaboration with the United Nations Population Fund (UNFPA), have developed ‘Frequently Asked Questions’ about the PNDT Act which will be useful to the people. This helps for stabilization of population. National Helpline service on reproductive health, mother health, child health, sexual health, adolescents health, infertility, contraception, and family planning etc. aims to reach out to adolescent, about to be married and newly married couples and who do not have easy access to reliable information on the above issues.

What is being done to prevent sex selective abortions?

Sex selective abortions are illegal in India. The Pre-natal Diagnostic Techniques (Regulation and Prevention of Misuse) Act, 1994, was enacted and brought into operation from 1st January, 1996, in order to check female foeticide. Rules have also been framed under the Act. The Act prohibits determination and disclosure of the sex of foetus. It also prohibits any advertisements relating to pre-natal determination of sex and prescribes punishment for its contravention. The person who contravenes the provisions of this Act is punishable with imprisonment and fine.

Recently, PNDT Act and Rules have been amended keeping in view the emerging technologies for selection of sex before and after conception and problems faced in the working of the implementation of the Act. These amendments have come into operation with effect from 14th February, 2003.

Under the Act, a person who seeks help for sex selection can face, at first conviction, imprisonment for a three-year period and be required to pay a fine of Rs.50,000. Medical professionals involved in sex selection can lose their registration and the right to practice, if convicted under the Act. However, officials admit that the Act is difficult to implement because sex selection happens within the confines of doctor-patient confidentiality.

Several Non-Government Organisations are active in fighting pre-birth sex selection. The issue is receiving attention of several health authorities which have begun monitoring clinics and hospital records for evidence of sex selection to mount action against them.

How is the preference for a son an impediment to population stabilisation?

Son preference is a major impediment to population stabilisation as it makes couples opt for larger number of children in order to ensure at least one male child in the family.

Son preference is evident in every State. However it is more pronounced in Uttar Pradesh, Rajasthan, Bihar, Haryana, Madhya Pradesh, Orissa and Arunachal Pradesh. These are also the States with high population growth rates. The weakest son preference is found in Tamil Nadu, Kerala, Karnataka and Goa, which are also the States that have achieved or are near achieving replacement level fertility. They also have better male-female ratio and higher female literacy levels. In richer States like Punjab, Haryana and Gujarat, couples are opting for smaller families but male preference leads to sex selection leading to adverse sex ratios.

Is sterilizing people an option?

Any form of coercion is in principle wrong and militates against basic human values and violates human rights. The suggestion that coercive sterilisation is an option flows from a mindset that looks at people as targets rather than as human beings with their own rights and needs.

That apart, experience of some of the Indian States clearly shows that it is possible to achieve replacement levels of fertility without compromising human rights and liberties. A comparison of the fertility decline in China and Kerala shows that Kerala achieved more than China without ever having to adopt any coercive policies. China's Total Fertility Rate (TFR) of 2.8 in 1979 dropped to 2.0 in 1991, while Kerala's TFR of 3.0 in 1979 dropped to 1.8 in 1991. Tamil Nadu had a similar decline from TFR of 3.6 in 1979 to 2.2. in 1991. Easy access to health services and women's education helped the fall in fertility rate in Kerala, while the most important factor in Tamil Nadu was the successful child nutrition support programme with focused interventions to meet contraceptive needs.

One of the most important factors which would bring down fertility levels is to meet the unmet need for contraception. This step can reduce fertility levels by almost 20%. Ensuring child survival can prevent another 20% of births.

The goal of child nutrition must be addressed separately. The "mid-day-meal" scheme in schools has increased enrolment as well as improved the nutritional status of children. This has proved to be effective in improving child survival and reduced the desire for larger families.

Incentives and Contraception

India's population programme in its early stages was driven by incentives in cash or in kind. Incentives were also given to service providers for motivating people to use contraception. Incentives were justified as inducements, compensation for loss of pay, and as a reward. Any incentive based programme is linked to targets and brings with it all the ills of a target-led approach and the possibility of misuse. What often follows is ill-informed consent, coercion, and resultant trauma to families. The situation gets worse when incentives are given to service providers to achieve contraception targets. This often leads to fudged figures and poor services.

So providing incentives is not a good way to promote contraceptive use. People have to be convinced about the need to space and limit families for their own good.

Youth and Population

Why do we need to focus on youth? Doesn't reproductive health start at marriage?

How India's population would grow in the future depends largely on the 189 million-plus people in the 15-24 age group. Meeting their needs for information and guidance regarding sexual and reproductive health behaviour, apart from education and employment opportunities, thus constitutes an important aspect of population and development programmes.

Adolescent sexual and reproductive health programmes enable them to make responsible and informed decisions.

This is particularly important in the case of young women, who should be empowered to exercise their right to greater control over their sexual and reproductive lives, free of coercion, discrimination and violence. Better communication about sexuality, about gender relations, and about the avoidance of unwanted pregnancy and sexually transmitted diseases will improve the quality of life of young people.

The importance of focusing on the adolescent girls and boys is supported by the following:

• About 25% of girls in the 15-19 age group have their first child before the age of 19 in India
• Pregnancy before age 18 carries many health risks. Teenagers are more likely to die in pregnancy or childbirth than women aged 20-24
• Adolescent mothers will have more children as they are less equipped to negotiate contraceptive use
• Adolescents account for 14% of abortions in India, according to the International Planned Parenthood Federation
• Raising the mother's age at first birth from 18 to 23 could reduce population momentum by over 40%, according to the United Nations Population Fund (UNFPA)
• Those under age 25 account for half of all HIV infections in India, according to the Joint United Nations Programme on HIV/AIDS.

Does giving sex education to adolescents encourage sexual promiscuity

No. Contrary to popular belief, sex education does not lead to promiscuity. In fact, such programmes lead to reduction in anxiety associated with unsafe sexual encounters and promote safe sex practices.

In a review by the World Health Organisation of 1,050 scientific articles on sex education programmes, researchers found "no support for the contention that sex education encourages sexual experimentation or increased activity. If any effect is observed, almost without exception, it is in the direction of postponed initiation of sexual intercourse and/or effective use of contraception".

Failure to provide appropriate and timely information "misses the opportunity of reducing the unwanted outcomes of unintended pregnancy and transmission of sexually transmitted diseases,, and is, therefore, in the disservice of our youth", the report says.

Adolescent reproductive and sexual health programmes should take parents and the community into confidence to build a supportive environment for the adolescents to exercise their choices. In the absence of such an integrated approach, there is a danger of the programme being resisted on misplaced fears of increased promiscuity. There is a need to work with both boys and girls together so that they appreciate the sexual and reproductive processes in both the sexes. This also leads to a proper understanding and exercising of sexual rights.

How does increase in age at marriage affect population stabilization

Marriage is near universal in India. Age at marriage is directly related to the education and employment opportunities available to women, with those better educated and employed marrying later than those who are uneducated and/or unemployed.

The mean age at marriage has increased steadily - from 17 years in the 1960s to 20 years in 1990s. Still, around 43% of women get married before 18 years, which is the legal age of marriage in India for women. One of the reasons for early marriage is also the fear that the girl may lose her virginity, the protection of which is considered as a responsibility of the family and seen as discharged by marriage.

Early marriages often lead to early pregnancies, as most women also conceive immediately because they lack knowledge and access to contraceptive services as well as face family pressure to present an heir within the first year of marriage. On the other hand, the desire to prove his "masculinity" by siring a child prevents a man from using contraceptive methods immediately after marriage. Giving birth to a child is also seen as a means of securing the marriage as there is greater pressure on the man to take responsibility for his wife when she is the mother of his child. Infidelity and desertion are more common when the woman has not had a child. Adolescent pregnancy, within marriage or otherwise, poses a threat to the health and survival of the mother and child. Loss of children makes the couple desire larger families.

At the macro level, early marriages and early child bearing result in faster replacement of generations, impeding population stabilization even when the couples opt for one or two children.