Dr Nithyanandha Prof IIM trichy
Context:
Dr. Usha Sriram, a healthcare specialist provided the social context to the falling fertility rates in India. Medically, the genetics have not changed in India over the last three decades. Thus the falling fertility rates in India are fundamentally related to socio-economic and environmental issues.
India cannot go back to older system of joint family, as the population moves to various locations searching for work and cannot stay together with the joint family. Also, India cannot go back to a time when families had three or more children, as the various socio-economic factors like education, healthcare, housing, etc., have become very expensive, especially in the urban area.
India is currently facing a peculiar problem of over population and low fertility rates. This can be observed at the granular data: the fertility rates are still high in the rural areas (at 2.2), but the urban areas are facing low fertility rates (1.6). This is fundamentally because of the socio-economic and environmental issues. While the rural life is fundamentally stress free and contented, the urban life is filled with late working hours, high work pressure and stress, because of which the fertility rate in both male and female population is dropping significantly. Because of such work related stress, families are also trying to defer planning for children. This could be because of the expectation of career growth, work related insecurities, and also lack of support from the employers in India.
When dealing with low fertility rates, the population that needs to be addressed is the 33Crores women in the age group of 15-49 years. While the ideal age for marriage is 24 years (after graduation and a couple of years of work to stabilize in their career), children have to be planned before 30 years. Any postponement in this could have significant and adverse impact on fertility rates and their chances of having children through natural process.
Factors responsible for low fertility rates in India
1. Employment related factors:
Companies in India, in addition to causing a lot of work-related stress, are also expecting that the employees contribute a lot of time towards work. In many states like Tamilnadu, the government has allowed the employers to extend the working hours from the existing eight hours to ten hours. Earlier factories were running on two shifts to produce goods. But due to capitalist forces and with an intention to earn more profits, many business owners have increased this to three shifts.
Today there is a lot more competition to secure government jobs as they are considered to be secure and does not have the hire-and-fire policy. There is also an added benefit of pensions on retirement available in such jobs. Because of this people prefer to get into government jobs despite it paying less salary for equivalent amount of work. The craze towards government jobs has led to unwanted stress in the minds of children who are forced to start preparation for securing a government job as early as 10th standard. Such craze has also resulted in corruption in recruitment, because of which families are forced to borrow money at exorbitant rates just to secure a government job. They do this with an expectation that they will be able to earn back the loan amount through other means (including becoming corrupt themselves). People who have gotten into government jobs this way are constantly under stress to recover the loan and keep looking for opportunities to earn extra money.
Such employment related aspects makes the employees very tired and stressed because of the work and they would be unable to focus on their family life and also planning for their children. The work related stress also has significant impact on their health and fertility rates.
2. Healthcare related factors:
The healthcare facilities in India have also been a significant factor in the low fertility rates in India. The healthcare facilities are not evenly distributed throughout the country. While there is a glut of hospitals and medical care centers in urban areas, the rural areas are completely ignored in terms of having hospitals and medical care. In many places, there is not even a primary health center in villages forcing the people to travel for more than 30 – 40kms to get the basic medical facilities. Given this situation, if a pregnant lady is about to deliver a baby and she does not have access to medical facilities, then it could lead to miscarriages or even the death of the lady. Resort to unprofessional and unhygienic methods because of lack of access to medical facilities could permanently damage the reproductive health of the mother, drastically bringing down the fertility rate in India.
3. Surrogacy and Artificial Reproductive Techniques (ARTs):
The doctor also highlighted that surrogacy cannot effectively solve low fertility rates in India because of three main reasons: One, it is very expensive; Second, it is regulated and is allowed only in certain cases where the parties are related, thus making the process of finding a surrogate mother very difficult; and Third, the surrogate mother always has the right to claim the child as her own and will always have attachment towards the child.
ARTs also cannot solve the problem of low fertility rates in India because of four main reasons: One, it is very expensive and costs anywhere between INR 4 – 6 lakhs per cycle; Two, achieving success within the first cycle is extremely rare and the family has to undergo at least 3 – 4 cycles to conceive; Three, with ART centers opening at all prominent places throughout the country, newly weds are not willing to wait even for one year to conceive naturally, and start trying ARTs like IVF within 3 – 4 months of marriage due to societal pressures; this could affect the ability to conceive naturally leading to low fertility rates in India; Four, the ARTs are extremely painful experience for both man and woman (more for the woman) and given the success rate and costs associated with ARTs, people lose hope very easily and very quickly and they stop trying to conceive naturally.
These methods could cause problems at later stages of life of the child. Because of all these complications, the doctor suggested that surrogacy and ARTs should be prescribed only for medical reasons especially in cases where the woman cannot conceive naturally or are born without uterus (and before prescribing it, sufficient time must be provided to try to conceive naturally).
4. Cost of living related factors:
The cost of living in India has been steadily increasing over the last decade. This could be because of the cost of education, or the cost of raising a girl child, or the cost of housing and other necessary infrastructure for a normal living.
The cost of primary education has increased significantly during the last couple of decades, fundamentally because of privatization of education. It is observed that politicians and industrialists, who are treating education as an industry with an intention of reaping huge profits year-on-year, own most of the private primary education institutions. After primary education, the higher education has been a challenge because of availability of lesser seats than the actual demand. Such costs relating to education are hindering families from raising children (or in some cases not more than one child), which in turn are adversely affecting fertility rates in India.
The cost of raising a girl child is excessively high in India. This is because the parents have to bear and manage the expenses relating to gold and other gifts to be provides to the boy at the time of her marriage. As the cost of gold has increased over the last couple of years, most parents are thinking hard about raising a girl child. This is also fundamentally responsible for female infanticide in India, which is another factor responsible for low fertility rates in India.
5. Child abuse related factors:
It was noted that because of the proliferation of internet and the influence of western culture, there has been a constant increase in child abuse cases, especially against young girls. While a few girls are able to get over the trauma of such abusive actions, most of them keep remembering about such trauma leading them to be wary of bearing children. In some extreme cases, there have been instances where the victims of such trauma have decided to become transgender men or may prefer lesbianism rather than lead a normal married life. Many such victims have also decided not to marry and would prefer to remain celibate throughout their life. Such abusive instances and its logical consequences have also been responsible for the falling fertility rates in India.
Another dimension of child abuse is the bullying of children by their schoolmates. This has been identified as one of the major factors that affect the psychological wellbeing of children and it also affects how they turn out to be as adults. Victims of bullying are found to have low self esteem, confidence, and a few of them also turn out to be psychotic cases. Many of the bulling activities that have sexual tinge to it could shape the sexual outcome of the child and many of them could turn out to be transgender, gay, lesbians, and also queers.
6. Lifestyle related factors:
Today’s generation in India is significantly influenced by the western culture. This is evidenced through various factors like food habits, clothing, music and entertainment, using technologies like mobile phones, and attitudes towards family life.
Current generation depends excessively on junk foods like pizzas, burgers, soft drink beverages, non-vegetarian food (especially chicken), and excessive sugar and salt. While these foods might not inherently cause any harm, they are not suited to the geographical conditions of India. The franchisor companies insist of using certain chemical flavors and taste enhancers that could be harmful to consumers. Not only that, the chicken that are farm-grown are being fed hormones, antibiotics, and also growth enhancers that are being passed on to consumers through the meat. It has been extensively recorded that girls who consume lot of junk food and chicken meat are attaining puberty much sooner (as early as 10 years). These hormones and growth enhancers are also causing multiple disorders among adult women like cysts, PCOD, fibrosis, lesions, excessive bleeding, excessive pain during periods, etc., all of which directly affect the sexual health of women thereby resulting in low fertility rate of India. Not only that, a recent study highlighted that the foods like vegetables, fruits, and grains contains high levels of pesticides and fertilizers and they might not be considered as edible in other parts of the world. In a recent event, a consignment of fruits exports to Europe was returned back to India on the grounds that it contained excessive amounts of fertilizers and pesticides. These fertilizers and pesticides significantly harm the health conditions of consumers leading to various ailments including cancer, and are also responsible for the low fertility rates in India.
Modern clothing like jeans and denim (especially the tight fitting ones) cause excessive heat within the body leading to health issues like rashes, skin allergies, and more importantly the reproductive health of both men and women, thereby adversely affecting the fertility rates in India. While clothing is a personal choice of citizens, the government should take measures sensitizing citizens of the problems they could face because of jeans and denim, while simultaneously highlighting the importance of clothing suitable to Indian conditions.
While music and entertainment is a freedom provided to the citizens by the Constitution of India, preservation of culture is also protected by the same constitution. The modern entertainment avenues promotes excessive aggression, excessive sexual content, and also promotes habits like smoking, alcohol, and narcotics. While these aspects can be censored, activists of freedom of speech have been succeeding in getting them passed in the media and entertainment content. Not only do they corrupt the minds of younger generation, they also make them addicts to things that could have adverse impact on their physical and psychological wellbeing.
There have been many studies that have recorded the harmful effects of the radiowaves being emitted from cellphones. With the current generation keeping multiple phones (especially in their pant pockets) causes irreversible harm to their reproductive wellbeing, thereby affecting the low fertility rates in India. This problem becomes aggravated because of the frequencies being used by mobile companies to transmit their signals to users phone. It has been recorded that except the government operated BSNL, every other mobile company is overshooting the signal strength prescribed to have a healthy condition.
Policy proposals to address low fertility rates:
1. Policy to address malnutrition and infant mortality:
The Government has to work towards creating a policy to address malnutrition, infant mortality (which is very high mainly due to malnutrition of both the baby and the mother), and also lack of sanitation. The Government should also ensure that the women get good quality of maternity care and post-delivery care after giving childbirth.
2. Policy to address lack of healthcare facilities in rural areas:
The Government should immediately think of setting up hospitals and healthcare centers in every nook and corner of the country. This not only provides access to medical care to citizens, it could also generate enormous employment opportunities for doctors in India. If the shortage of doctors is a concern, then the government should consider creating a new set of medical professional which paramedical skills essential to treat the regular ailments in such rural areas and they should also be provided with necessary infrastructure that could be accessed for emergency medical care that could not be handled by such paramedical professionals. But providing healthcare facilities in the rural areas is very critical to maintain and increase the fertility rates in India.
3. Policy to address maternity benefits to unorganized sector:
While the Government has brought out policies to enable maternity benefits to mothers working in the organized sector, women working in unorganized sector do not get this benefit. The new Labour Codes enacted by the Government of India should introduce such benefits to women working in unorganized sector as well.
4. Policy to implement the existing labour laws:
It has also been noticed that most of the companies (including a lot of government of India institutions and organizations) do not provide the facility of crèche for its employees. If crèche were available within the office premises as mandated by the law, then most working families would feel comfortable planning for children. If the company does not provide for such facilities within its premises, as most of them are nuclear families without the support of their parents and relatives to take care of the child at home, parents would not be comfortable to plan and bear children, which again bring down the fertility rate in India. The Government should ensure that all the eligible companies setup crèche facilities within its office premises.
5. Policy to bring down the cost of healthcare:
Today, the cost of healthcare for families planning for children is exorbitant. This could be because of the essential nutrition required by the mother, or the necessary tests and investigations to be carried out during pregnancy, or the costs associated with delivering the baby and post-delivery care for the mother and the baby. The Government of India has to take immediate and serious measures to bring down the cost of healthcare and/or provide equivalent services at affordable prices in government run hospitals. It could also speed up the process of setting up institutions like AIIMS in all states and regions with an objective of providing affordable healthcare to families planning for children.
6. Policy to bring down the cost of education:
It is observed that the government provides high quality education through the institutions under its control, especially at the higher education level. The Government of India should take appropriate policy action to increase the availability of seats in such institutions to ensure that the seats are easily available to most students attempting to get into such institutions. However, the government should take strong policy measures (including, but not limited to thinking about nationalizing private primary educational institutions providing good quality education) to bring down the cost of quality primary education, in order make it affordable for most households.
7. Policy to bring down the cost of raising girl child:
While there are laws prohibiting dowry, it is not being properly enforced in most parts of India. Dowry is one of the main reasons for female infanticide in India, and also a one of the significant causes for the low fertility rates in India. In order to curb this, the government should not only frame policies, but also ensure its strict implementation to curb practices relating to dowry at all levels in India. It should also implement policies to curb female infanticide more strictly.
8. Policy to strictly implement child abuse related laws:
While the government has enacted legislations like POCSO Act 2012, the government should expand the scope of child abuse cases to include mental harassment by telling sexual stories, abusive behavior towards children, and also peer pressure related cases. The legislation also expects that the matter be reported to the authorities. If the perpetrator is a family member, then matters will not get reported. The Government should review this legislation and amend it suitably to not only strictly implement this legislation, but also expand the success of this legislation in preventing child abuse instances.
9. Policy to curb bullying in schools:
While there no specific laws dealing with bullying in schools, the national Commission for Protection of Child Rights, in its policy document, has indicated that action against bullying in schools can be initiated under POCSO Act 2012, and Juvenile Justice Act of 2015. It also recommends the formation of Anti-Bullying Committees in schools to prevent such bullying. But this committee feels that the government should enact a separate legislation to curb bulling in schools, in school transportation, in tutoring centers, and also in residential areas, in order to protect the psychological wellbeing of children and also help them grow into mature adults with responsible heterosexual bent, as well as respectful attitude and behavior to towards their partners. Once this is achieved, it can also help improve the fertility rate in India.
10. Policy to regulate the quality of food in India:
Government should frame strict policies that prohibit the usage of hormones, antibiotics, and growth enhancers in farm-bred poultry. In addition, it should also frame policies that could regulate the quantity of fertilizers and pesticides in food items that are consumed by citizens in India. These measures would serve multiple purposes: it would improve the health condition of our citizens, it would reduce the costs associated with medical care, and also it would help improve fertility rates in India.
11. Policy to promote clothing suitable for India:
The government should take up a policy project highlighting the health issues resulting from jeans and denim. It should also sensitive the current generation about the benefits of clothing suitable to Indian weather conditions and also promote it as being trendy and suitable to the younger generation.
12. Policy to regulate depiction of excessive aggression, sexual content, and habits like smoking, alcohol, and narcotics:
The government should promote policies that regulates depiction of excessive aggression, sexual content, and habits like smoking, alcohol, and narcotics in entertainment media, social media, internet media, and also in electronic communication media like whatsapp, etc. This not only helps keep the mind from being corrupted, it would also lead to physical and psychological wellbeing of citizens in India.
13. Policy to regulate the signal strength of mobile companies:
The government should promote policies to strictly enforce the rule that mobile companies should not exceed the signal strength and frequency range that have been mandated under the law. It should also enforce mechanism to impose heavy penalties including taking care of the medical treatment of citizens adversely affected by the breach of such regulatory limits.
14. Policy to promote about fertility and reproductive health using influencers:
The government should adopt policies to sensitize women and girls all over the country about their reproductive health and the importance of fertility rate for the development of India. For this the Government can also take the help of social media influencers and religious gurus to communicate such message to the relevant younger generation and the older generations respectively.
