CHENNAI: The National Family Health Survey 2023-24 (NFHS-6), the findings of which were released last week, has a lot of affirming print that should make Tamil Nadu’s policy establishment happy.
The state continues to be a high performer on several counts. For instance, 99.7% of all births now take place under professional supervision; stunting among children under five is down to 20.7% from 25.0% in NFHS-5 (2019-21); and more than 90% of children aged 12 to 23 months are fully vaccinated. As a whole, the findings attest to the impressive work by the administration over a long period to improve access to institutional healthcare and raise maternal health and child nutrition parameters.
However, a major point of concern for the state is the fall in its total fertility rate (TFR), the average number of children a woman is likely to have during childbearing years (15-49). Tamil Nadu’s TFR has fallen from 1.8 in NFHS-5 to 1.7 now. The other southern states also have TFRs below 2.1—the level necessary to keep the population stable in the coming decades—but they have improved while Tamil Nadu has slid. Telangana’s TFR has risen to 1.9 from 1.8, while Andhra Pradesh and Karnataka improved marginally to 1.8 and Kerala remained unchanged at 1.8.
Projecting from Tamil Nadu’s falling TFR, the state’s population will likely peak and start to decline within the next 20 years. The median age is forecast to rise sharply, increasing from the late 20s today to the mid-30s. The working-age population (15-59) is likely to shrink, and the 60+ cohort could increase from 13.7% of the population now to 15.8%.
At a median age approaching 40, Tamil Nadu will start to experience the same difficulties that confront today’s demographic basket cases like Japan, Italy, and Germany. These include a slowdown in economic growth, higher welfare dependency, labour shortages, higher healthcare costs, reduced innovation, and societal frictions due to in-migration.
The falling TFR in NFHS-6 is an alarm bell for Tamil Nadu. The state needs to pivot from ‘family planning’ to ‘population care’, as Andhra Pradesh has recently done. That neighbouring state was the first in the South to address the problem of low TFR. Its Population Management Policy includes a cash incentive of Rs 25,000 for a woman having a second child, and monthly support of Rs 1,000 for 5 years plus free education until age 18 for a third child. The policy also offers one year of maternity leave for mothers and two months of paternity leave for fathers.
However, incentives are only a starting point to tackle the challenge of low TFRs, which are the outcome of a long and complex interplay of socioeconomic and demographic processes, most of them gendered. Also, much of the good work done by governments on women’s empowerment tends to feed a low birth rate. Greater literacy, professional employment, economic independence, awareness of reproductive rights and health, access to institutional healthcare all negatively correlate with the birth rate.
The challenge for Tamil Nadu’s policymakers therefore is to synchronise two processes headed in opposite directions. For that to happen, it is important for them to wake up to the alarm bells, as Andhra Pradesh has done, and include population management into the policy design of every programme.