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By M P Basheer After having consistently followed the 'We Two, Our Two' family planning model, Keralites are now beginning to feel that, 20 years from now, when there are too many elderly, two will be too few. By 2022, around 33 per cent of Kerala's population is expected to be aged over 49, leaving a gap in the support system
In the area of population growth (rather, `non-growth'), Kerala remains its neighbour's envy. But it is not the owner's pride anymore. The state may just have carried the 'We Two, Our Two' model of family planning too far. Today, Kerala faces new problems. About 1,700 primary schools have been categorised as 'uneconomical' because there are too few students. More than 25,000 teachers are likely to lose their jobs. Over a dozen revenue villages are to be 'dissolved' or re-organised as there are not enough residents. Worse still is the fact that by 2022, around 33 per cent of Kerala's population will be aged over 49, leaving a gap in the support system. As India's population growth rate surges forward, the growth rate in the densely-populated Kerala is nearing the great magical zero mark. In a few years, the number of births and deaths in the state will be equal. Recent studies reveal that Kerala is at a point of crucial demographic transition. Couples with three or more children are being replaced by those with two or less. The fertility level is already below the replacement level. "Though the birth rate is on the decline, the number of women in the reproductive age-group is still high owing to the backlog from previous years and teenage marriages in certain sections. Once this backlog is cleared, Kerala will touch zero population growth," says a recent study conducted by the Centre for Development Studies (CDS), Thiruvanathapuram. From an average of six children per woman in the 1950s, the fertility rate dropped to 2.8 in 1981 and 1.7 in 1996. This decline in female fertility is about 40 per cent against a national average of 20 per cent. The result: Most Malayalee couples today have two or less than two children. Demographers attribute this change to a high literacy rate and relatively late marriages. As per the CDS study, which was carried out by Dr K C Zacharia, the birth rate in the state is marginally ahead of the death rate, with 14 births against nine deaths per 1,000 in a year. It will take one more generation, or roughly 20 years, to close this gap. "By the year 2015, the population growth in Kerala will probably reach stagnation. Beyond that, any rise in the mortality rate will result in a drop in actual population," observes Dr Zacharia. Kerala has also set a new milestone in the matter of infant mortality rate: 13 infant deaths against 67 per 1,000 for the rest of the country in a year. That means a drop of 66 per cent during the 15-year period from 1981 to 1996; the national average came down by a mere 20 per cent. In Kerala, more than one-fifth of under-five deaths occur in the neonatal period, one-half during the early days of birth and about one-tenth on the actual date of birth itself. What's worrying policy-makers, however, is the growing number of elderly persons among the population. Demographic expert V Ramankutty says: "By 2021, the population structure of Kerala will be characterised by a significant number of people over 60 years." Currently, elderly persons account for 10 per cent of the state's population as against the national average of seven per cent. The proportion of people above the age of 49 increased from 15.8 per cent in 1991 to 19.4 per cent in 2001. And it is expected to grow to 24.8 per cent in 2011 and 33 per cent in 2021. "One of the consequences of this shift will be the increasing number of persons affected by chronic diseases which will put an additional burden of around Rs 9,000 million, at the present cost rates, on the exchequer for treatment," says Ramankutty. The outcome is clear. A life-expectancy boom and sputtering birth rates have brought for Kerala an unavoidable demographic concommitant: Too many old people with not enough young men and women with free time or the desire to look after them. The number of people between the ages of 60 and 75 has been growing at the rate of four per cent annually -- far quicker than the overall annual population growth rate of a little over one per cent, say latest figures compiled by the state's planning board. "It's called demographic transition, and is a recent phenomenon," explains planning board vice-chairman V Ramachandran. The reasons for the growing 'generation gap' are high life expectancy (73 years), stringent birth control and low infant mortality rates. With Kerala slated to achieve zero population growth in a few years, the problem can only get worse. A large number of people who are too old to contribute to economic production will place too great a burden on a state that is small, not very financially healthy, and beset with numerous socio-economic problems. "It's a pressing problem that needs serious attention," says Ramachandran. Geriatrician Jothydev believes that younger generations owe a debt to the elderly. "Loneliness is the biggest problem. We do not have a single geriatric centre," she says. The silver lining is that about 70 per cent of the elderly have independent sources of income. The problem, however, is that half these people are agricultural labourers, and their having to work beyond a point raises questions of health and of morality. Interestingly, the population structure in China and Kerala, both places where communism still lingers, are somewhat similar. Though a large elderly population is a feature of developed nations that have adequate delivery systems for them, Kerala and China suffer the same problem without the support systems to offset it. This forces their cash-strapped governments to support the boom in the number of elderly. The proportion of people over 65 years in China is expected to rise to 10.9 per cent in 2020 while the number of people over 60 in Kerala, which now stands at around 10 per cent, is likely to increase to 15.07 per cent of the population by 2011. The main reason for the success of the family planning programme in Kerala is that it did not target mothers directly as did other states. Family planning was made a part of the healthcare system so that every woman who went to a hospital or dispensary to immunise her child returned with the `small family' message. "We have placed the population control programme squarely in the developmental context and decided to move from demographic goals to individual and community needs," says Ishita Roy, state social welfare director. Women who were initially turned off by the aggressive targeting began to respond positively to the programme once it focused on the health of their children. Family planning succeeded in Kerala because of various factors ranging from education and land reforms to cultural heritage. Towards the end of the 1960s, education acquired economic dimensions. Land reforms brought down the status of land as an investment option. Today, an average Malayalee family prefers to invest in its children's education in anticipation of long-term financial advantages. Changing social conditions helped create an atmosphere that compelled couples to opt for smaller families. As more and more women stepped out of their homes to work, sterilisation became a welcome option. For working mothers who wanted to avoid the hassles of consecutive pregnancy and child-rearing, the nuclear family became a practical necessity. Meanwhile, the sterilisation drive gradually gained momentum, with vasectomies giving way to tubectomies. Couples practised temporary birth control using the pill and IUD. Backward communities like the Ezhavas, who once favoured large families, have now accepted the idea of a small family. Kerala's Malappuram district, one of the very few districts in the country where Muslims are in a majority, has registered a two-digit fall in the decadal rate of population growth. This is significant because Muslims are traditionally considered hostile towards family planning. Malappuram's Muslims are taking to family planning in a big way -- this positive trend is indicative of social changes taking place within the community.
According to the Census of India, 2001, Malappuram recorded the biggest decline in population growth. Between 1991 and 2001, the population rose by 17.22 per cent. Although still a pretty high figure, it's a steep 11.65 per cent fall since 1991. However, Malappuram district, with its 4.3 million people, has the highest rate of population growth among the state's 14 districts. The district has the highest fertility and infant mortality rates too. Moreover, teenage marriages and pregnancies are still rampant in this backward district. A study carried out as part of the district Reproductive Health Project showed that out of 2,918 married women in the reproductive age group surveyed, 53 per cent were married at an average age of 15. Most of them became pregnant during their first year of marriage. The Union Ministry of Health and Family Welfare has identified Malappuram as one of the 90 problem districts in the country for its high rate of population growth, high infant mortality, reduced longevity, large family size and low health status. The fall in birth rate is an indication of a conscious decision on the part of individual couples to limit the size of their family and also the widespread use of contraceptives. The government played no role here; there was no special drive towards birth control in the district. (M P Basheer is a journalist based in Kochi, Kerala) The Quest Features & Footage
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