National Human Development Report: 2001 - Indira Gandhi Institute ...

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NATIONAL HUMAN DEVELOPMENT REPORT 2001 HEALTH ATTAINMENTS & DEMOGRAPHIC CONCERNS 77played a significant role. It alsoappears that factors influencing thedecision-making process athousehold level, such asparticipation of women in decisionmakingdue to their empowermentbrought about by spread ofeducation or other specific factors,have had a decisive role to play.These influences stand out in thesuccess of demographic transition inthe States of Kerala, Manipur andHimachal Pradesh. However, ineach of these cases, as well as in caseof Tamil Nadu and Andhra Pradesh,there are other specific andcontextual factors that may havealso helped in bringing about adecline in TFRs and, hence, inpopulation growth rate. While therecannot be a single model ofsuccessful demographic transition,particularly from the point of itsapplication to other States of thecountry, there is much to be learntfrom each of these success stories.The level of fertility has been,generally, found to be higher atlower education levels of theparents. According to a studyundertaken by the Registrar Generalof India for the year 1984, it wasfound that the TFR declinedprogressively with the level ofeducation of the mothers. It was thehighest (5.1) for illiterate womenand lowest (2.4) for women who hadstudied at least up to matriculation.The TFR initially increased with thelevel of household income anddeclined after a certain level. It wasalso seen that at the national levelthe TFR was least among the Sikhsand Christians and the highest forMuslims. The TFR was higher forScheduled Castes/Scheduled Tribesin comparison to the others.Overall, TFR was lower in urbanareas than in rural areas. Similarfindings were reported by theNFHS-I and II. They reported thatfertility was higher among rural, lessPopulation (Million)Birth/Death Rates (Per Thousand)Birth and Death Rates6050403020100Census YearsBirth RatePopulation and Growth Rate1,2001,00080060040020001901-111911-211921-311931-411941-511951-611961-711901-111911-211921-311931-411941-511951-611961-71Census YearsPopulation1971-811981-91Death Rate1971-811981-91Growth Rate1991-20011991-962.52.01.51.00.50.0-0.51996-01Growth Rate (Percentage)
78HEALTH ATTAINMENTS & DEMOGRAPHIC CONCERNSNATIONAL HUMAN DEVELOPMENT REPORT 2001Towards Population Stabilisation —Models of Successful Demographic TransitionIn India, apart from Kerala — the most frequently quotedState for not only recording impressive attainments on anumber of social indicators — the States of Manipur,Himachal Pradesh, Tamil Nadu, Karnataka and AndhraPradesh present successful models of demographictransition. While there are some common elements acrossthese States, each of them has some unique characteristicsthat explain their recent performance.KeralaKerala’s birth, death, infant mortality and literacy ratescompare favourably even with countries having much higherincome levels. It is all the more creditable that these havebeen achieved in a democratic set up without any coercivemeasures. There are several factors that explain Kerala’sperformance but most of these are not easily replicable inother States. Historically, the benevolent rulers ofTravancore and Cochin had enlightened policy towardshealth and education that paved the way for a humandevelopment strategy for the State. Several massmovements led by social reformers and visionaries helpedmobilise the masses and empowered them to fight for theirrights. This led to a high degree of political consciousnessand social awareness. Christian Missionaries have played apioneering role in promoting health and education. Theycontinue to manage accessible and affordable hospitals,schools and colleges in the State. Effective implementationof land reforms under the Communist Governments createda high degree of motivation for education, which hasyielded long-term social dividends to Kerala. As a result ofthe land reforms, those who lost land and those who gotsmall parcels of land realised the need for alternate sourceof income and, hence, turned to education in a big way.Matrilineal System, though confined to certain highercastes, created a helpful social environment and a higherstatus of women compared to other States in India. Themarriage age of girls and boys increased continuously andthis made a significant impact on birth rate. Late marriagesand educated mothers resulted in lower rates of maternal,infant and child mortality and higher practice ofcontraception. Massive investment in health and educationcombined with good administration, private and civilsociety participation helped in enriching the humanresource development strategy, yielding better healthstandards and adoption of small family norms. Effectivemanagement of Government’s family planning programmeand contribution of private doctors and charitable hospitalshave played a significant role in reducing mortality andfertility rates. The widespread coverage of print andelectronic media along with cinema in the State helpedimprove communication and publicity for the spread offamily planning concerns and practices. A rural-urbancontinuum in human habitations and well developedtransportation network — by road and water — improvedaccessibility to health services and education. Finally,migration in large number has always been a feature ofKerala’s development. Apart from easing populationpressure and unemployment, migration has brought inconsiderable monetary remittances to families in Kerala,which has improved the living standards.ManipurEven in 1981, Manipur had the distinction of having thelowest infant mortality rate in the country, even lower thanKerala and yet, not much is known about the Manipurmodel. There are many similarities in social and institutionalcontext facilitating such outcomes in the two States, butthere are also many differences. Both Kerala and Manipurhave better availability and a more equitable distribution ofhealth services in comparison to rest of the country. While,the physical provisioning and access to health services isperhaps better in Kerala than in Manipur, the proportion ofcurrent expenditure (both public and private) on health careand related facilities is far more in Manipur than in presentday Kerala. Like Kerala, Manipur is not among the moreeconomically prosperous States in India. In fact, its percapita Net State Domestic Product, which was around 85 to90 per cent of the national average in early eighties,declined to about 65 to 70 per cent of the national average,in the second half of nineties. However, the NSSO per capitaconsumption expenditure for the State fares well incomparison to the national average, particularly for ruralareas. It is important to note that among the States (anddata problems notwithstanding), the inequality in percapita consumption expenditure, as measured by the GiniRatio, for Manipur is among the lowest in India. BothManipur and Kerala have a far more equitable distribution oflandholdings than the so called ‘BIMARU’ States. What isstriking that, unlike Kerala, the level of female literacy inManipur is not significantly high, it is in fact around thenational average. Women’s empowerment brought about byits unique socio-cultural context, and not so much byfemale literacy, explains the impressive health attainmentsof the State. Greater women’s freedom; increased politicalconsciousness and participation facilitated, in part, by the
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indiaLong years ago we made a tryst
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NATIONAL HUMAN DEVELOPMENT REPORT 2
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iiFOREWORDNATIONAL HUMAN DEVELOPMEN
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ivCONTENTSNATIONAL HUMAN DEVELOPMEN
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2OVERVIEW NATIONAL HUMAN DEVELOPMEN
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4OVERVIEWNATIONAL HUMAN DEVELOPMENT
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6OVERVIEWNATIONAL HUMAN DEVELOPMENT
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8STATE OF HUMAN DEVELOPMENT NATIONA
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10STATE OF HUMAN DEVELOPMENTNATIONA
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Page 33 and 34: 26STATE OF HUMAN DEVELOPMENTNATIONA
Page 39 and 40: 32ECONOMIC ATTAINMENTS AND WELL-BEI
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Page 71 and 72: 64HEALTH ATTAINMENTS & DEMOGRAPHIC
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Page 97 and 98: 90SOME OTHER ASPECTS OF WELL-BEING
Page 99 and 100: 92SOME OTHER ASPECTS OF WELL-BEINGN
Page 121 and 122: 114GOVERNANCE FOR HUMAN DEVELOPMENT
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128GOVERNANCE FOR HUMAN DEVELOPMENT
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130GOVERNANCE FOR HUMAN DEVELOPMENT
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132TECHNICAL APPENDIXNATIONAL HUMAN
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134BIBLIOGRAPHYNATIONAL HUMAN DEVEL
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136BIBLIOGRAPHYNATIONAL HUMAN DEVEL
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138GLOSSARYNATIONAL HUMAN DEVELOPME
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140THE STATE OF HUMAN DEVELOPMENTNA
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146INDICATORS ON ECONOMIC ATTAINMEN
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