In a first-of-its-kind initiative, the Andhra Pradesh government last week introduced a draft Population Management Policy in the Legislative Assembly, which aims to incentivise families to have two or three children, and provide better healthcare facilities, particularly catering to women.
The policy also strives to improve old age care to the elderly, whose population is expected to steadily increase in the coming years.
The proposed policy of the N Chandrababu Naidu-led government is a direct response to the state’s falling fertility rates, which is among the lowest in the country, well below the replacement level fertility of 2.1. The total fertility rate (TFR) of Andhra Pradesh has dropped to 1.5, meaning that, on an average, a woman in the state is producing only 1.5 children.
Naidu has been one of India’s few political leaders who have publicly expressed concern at the declining trend, and has urged families to produce more children. Fewer children being born results in a shrinking working population and a relatively higher proportion of older people needing support and care. This can affect economic productivity, and put a stress on government finances, turning a demographic dividend into a demographic burden.
Andhra’s demographics
Andhra Pradesh’s total fertility rate has steadily declined from 2.2 in 2003 (for the combined state of Andhra Pradesh and Telangana) to 1.5 in 2023, the last year for which data is available. Telangana, which was carved out in 2014, has had exactly the same TFR as Andhra Pradesh.
The trend is not unique to these two states, for that matter. For India as a whole, it has declined from 3 in 2003 to 1.9 now. Falling TFR is generally a sign of development and prosperity. It is strongly correlated with improved education and healthcare, particularly of women, increasing levels of urbanisation, rising income levels, and a trend towards nuclear families.
Countries worldwide have followed similar trajectories. In India, the southern states, which have had much better social indicators than states in the north and east, have always had TFRs well below the national average. This has gone down further in the last two decades. Tamil Nadu has a TFR of 1.3 while Karnataka and Kerala are at par with Andhra Pradesh and Telangana at 1.5.
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On the other hand, Bihar has a TFR of 2.8 and Uttar Pradesh 2.6. Madhya Pradesh, Chhattisgarh, Rajasthan, Jharkhand, and Assam are other major states whose TFRs are higher than the national average.
The political response to these trends has come out in different ways. While Naidu has focused his attention mainly on the economic impacts of declining fertility rates in his state, Tamil Nadu Chief Minister M K Stalin has spoken about the implications of declining population on the representation of southern states in the Parliament. The populations of southern states have, over the years, declined, relative to states like Uttar Pradesh or Bihar. This would impact the relative number of parliamentary constituencies in every state, which is decided on the basis of population. Southern states can see their relative representational strength in the Parliament going down.
This is why the constitutional mandate of delimitation, a periodic exercise to redefine Parliamentary constituencies on the basis of every Census, has been kept suspended for the last 50 years. But with the suspension ending this year, and the government seemingly determined not to extend it further, this question is expected to come back to political prominence very soon.
Policy objectives
Andhra Pradesh is the first state to initiate a targeted policy to reverse the demographic trend. While introducing the draft policy in the state legislature on Thursday (March 5), Naidu said it could be a game-changer for the state.
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The policy has five elements: Matrutva, focused on maternal well-being; Shakti, aiming for greater female participation in workforce; Kshema, targeted at senior citizens; Naipunyam, geared towards skilling the workforce for future needs, including healthcare needs of children and elderly; and Sanjeevani, seeking to strengthen the state’s digital public health delivery system.
Under the policy, the state government intends to provide a cash incentive of Rs 25,000 on the birth of a second or third child. In case of the third child, Rs 1,000 per month is proposed to be given for the first five years for ensuring nutritional supplements. Free education is proposed for the second and third child till 18 years of age in government institutions.
State government employees nearing retirement would be eligible for Rs 50,000 and 15 days of leave to focus on preventive health check-ups. In-vitro fertilisation procedures are sought to be subsidised through public-private partnership models to help the nearly 11.7 lakh infertile couples in the state.
The state government has also set a few targets to be achieved through this policy. It hopes to bring down the proportion of C-section births in the state from 67.5 per cent to less than 40 per cent by tackling perverse incentives offered by private hospitals for this purpose. Couples are apparently less inclined to go in for more children after one C-section birth, and the government wants to ensure that this process is undertaken only in case of need, and not incentivised for everyone. Similarly, it hopes to significantly cut down on teenage pregnancies, and reduce sterilisation procedures amongst males.
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The policy also seeks to train at least 10,000 healthcare assistants every year, equipped mainly to handle the needs of adolescents and elderly.
The Naidu government is hoping that this shift in focus from “population control” to “population management” will not just arrest the decline in fertility rates, but would also address the associated issues of old age care, and women’s health. Andhra Pradesh has a population that is ageing faster than the national average. The median age of the population is 32.5 years, compared to 28.4 years for the country as a whole. Nearly 10 per cent of its population is above the age of 60, which is projected to rise to 23 per cent by 2047. Female participation in the workforce is about 31 per cent — much lower than the 37 per cent national average.
Naidu said the state government had a small window of opportunity to address these issues. “If the state does not intervene now, the economic structure of the state will crumble,’’ he said.
(with inputs from Amitabh Sinha)
