Health of the nation
The Indian Express Delhi|January 10, 2022
National Family Health Survey-5 indicates progress has been made in all areas, population will stabilise by 2050. In some states, public health risks call for targeted policy intervention
CRANGARAJAN AND JK SATIA

THE RECENT NATIONAL Family Health Survey (NFHS-5,2019-21 has shown that fertility continues to decline in India. The Total Fertility Rate (TFR) – the number of children a woman can be expected to have during her lifetime - has declined from 2.2(NFHS-4, 2015-16) to 2.0, below the replacement rate of 2.1, where a mother is replaced by a daughter. Will fertility continue to decline? From an estimated TFR of around 6 in 1951, the rate declined to 5.2 in 1971, 3.6 in 1991 and 2.4 in 2011, according to the SRS report 2018. Since 2000, the pace of decline in TFR may have slowed. As the TFR in most states declined during the period 201516 and 2019-21 (Table 1), we can expect it to continue to decline for some time.

However, the data reveals that there may be some resistance to a very low fertility regime. Both Kerala and Tamil Nadu show the TFR rising from 1.6 and 1.7 respectively to 1.8 during this period. Only a few large states have a TFR below 1.7 -Punjab, West Bengal and the UT of Jammu and Kashmir.

The two states with the highest fertility rate – Bihar (TFR 3.0) and Uttar Pradesh (TFR 2.4) – require special attention as together, they comprise nearly a fourth of India's population.

The TFR in UP was higher than in Bihar until about 2000. Since then, the TFR declined at a faster pace in UP. Family planning and maternal and child health (MCH) programmes, as well as improvement in women's status, are known to be major drivers of fertility decline.

Both Bihar and UP need to strengthen their programmes. The contraceptive prevalence rate (CPR) by modern methods is nearly the same in both states at around 44.5 per cent compared to 56.5 per cent for India as a whole.

However, the CPR by all methods (modern and other methods such as rhythm) is higher in UP(62.4 per cent) compared to Bihar(55.8 per cent), although both are lower than India (66.7 per cent).

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