Bihar population problem: 94% women know about contraception, 20% use them

In roughly five years, or by 2024, the population of India is expected to surpass that of China, according to a 2017 United Nations (UN) projection.

Married early, Premlata Devi had had four children by the time she was 24 years old--a boy and three girls. A homemaker from Tikari block in southern Bihar’s Gaya district, she had had a copper intrauterine device (IUD, the most common brand name being Copper-T) inserted for contraception after the birth of her second child.

Six years later, she had got it removed because of abdominal pains and increased uterine bleeding, both known side-effects of the device. “I no longer want to use Copper-T,” she said.

After the removal of the IUD, Premlata Devi went on to have two more children that she had not planned for. Neither she nor her husband know of alternative methods of contraception, she said. And the health workers, who under the National Health Mission are supposed to counsel women like her, never did show up.

Stories like these are common in Bihar, India’s fifth poorest state and third most populous, with India’s highest total fertility rate (TFR)--3.4 children per woman, according to 2015-16 government data, the latest available. This TFR exceeds that of India’s most populous states: Uttar Pradesh (2.74) and Maharashtra (1.87). The national average is 2.18. (Sikkim and Kerala had the lowest TFR for 2015-16: 1.17.)

In roughly five years, or by 2024, the population of India is expected to surpass that of China, according to a 2017 United Nations (UN) projection. China’s population will peak at 1.44 billion in 2029 and then start declining.

Due to what is called population momentum--a higher proportion of people in the reproductive age group--as well as higher life expectancy, India’s population will only peak in the 2060s, before it starts to decline, according to current estimates.

However, Indian fertility rates are declining, and some of these estimates are revised constantly. For example, according to earlier UN estimates, India was to overtake China in 2022. Ten years ago, India had a TFR of 2.68; today, according to the National Family Health Survey 4 (NFHS 2015-16), out of the 36 states and union territories (UTs), only four--Uttar Pradesh (UP), Bihar, Meghalaya and Nagaland--have a TFR more than or equal to 2.68.

Yet, as many as 12 states have a TFR above 2.1, termed the replacement-level rate, at which the population remains constant.

Business Standard