India Is World's Most Populous Nation Now: What That Means For Women's Rights And Health

India on Wednesday surpassed China to become the world’s most populous country with a population of 142.86 crores against China’s 142.57 crores. China has now become the second most populous country, according to the United Nations world population data. 

The report further states that this is the first time that India has topped the UN list of the most populous countries since the time the international organisation started collecting data in 1950. 

In November last year, the UN estimated that India will become the most populous country by 2023 and was the largest contributor to the milestone of the global population of “8 billion” people. 

However, what does it mean for India to become the world’s most populous country in terms of advancement of medicine, access to health and rate of fertility?

India’s decreasing TFR

India is projected to have a population of 1.668 billion in 2050, ahead of China’s 1.317 billion people by the middle of the century. The population is set to rise to 1.515 billion in 2030, from 1.417 billion in 2022.

Although the report states that India’s population is set to surpass China, the numbers should not be coming as a shock, experts believe. 

A report by India Spend quoted  Poonam Muttreja, executive director of the Population Foundation of India, saying that 31 states and Union Territories in India have reached the (population) replacement level of 2.1. This is also known as the Total Fertility Rate (TFR), which means the average number of children a woman of child-bearing age must have. This of course means, that a woman must have 2 children and the extra, 01, indicates children who die in infancy or women who die before childbirth. A TFR of 2.1 will help in stabilising the population. 
Three years ago, the National Family Health Survey (NFHS)-4 found India’s TFR had already reached 2.2. Most Indian states had already achieved or were below 2.1 TFR.

However, UNFPA notes that India’s TFR has declined from 2.2 to 2.0 at the national level. The country reached the national replacement level of fertility in 2020, but this replacement level is not even across all of India. 

While 31 States and Union Territories with 69.7% of the country’s population have reached below the replacement rate of 2.1, TFR is above the national average in states like Bihar, Meghalaya, Manipur, Uttar Pradesh, Jharkhand and Madhya Pradesh. 

India’s National Programme for Family Planning was launched way back in 1952 and the National Population Policy in 2000.  UNFPA concludes, “This indicates significant improvements in access to family planning-related information and services. In summary, it shows that India’s national population policies and health systems are working.” 

The main reasons for the decline in fertility include an increase in the adoption of modern family planning methods and a reduction in the unmet need for family planning.  
Further, with the increasing marriage age,  fertility has declined although one in every five children gets married below the legal age. 

Further, a look at growing population anxiety about women’s body rights

With the population reaching a whopping number, in India and abroad, it becomes a sign of certain positive indicators to analyse; it means that women are surviving pregnancy, more children are making it through the initial precarious months of life, medicine has been advancing and people are living healthier lives. 

However, despite the “milestone” of “8 billion people” representing historic advances for humanity in medicine, science, health, agriculture and education, the growing population is often met with a considerable amount of anxiety. The burden of this anxiety largely falls on women and their health which is closely intertwined with women’s body rights across the world. 

A report, “8 Billion Lives, Infinite Possibilities: The case for rights and choices”, by the United Nations Population Fund (UNFPA), released today, April 19, reveals population anxieties are widespread and governments are increasingly adopting policies aimed at raising, lowering or maintaining fertility rates. But efforts to influence fertility rates are very often ineffective and can erode women’s rights.

History has shown that fertility policies designed to increase or lower birth rates are very often
ineffective and can undermine women’s rights. The report adds that many countries have rolled out programmes to engineer larger families by offering financial incentives and rewards to women and their partners, yet they continue to see birth rates below two children per woman. And efforts to slow population growth through forced sterilization and coercive contraception have grossly violated human rights.

What is the picture in India in terms of women’s rights and anxiety? 

The State of the World Population Report (SWOP) by the UN released on Wednesday states that India with the largest youth cohort—its 254 million youth (15-24 years) can be a source of innovation, new thinking and lasting solutions. The trajectory can leapfrog forward if women and girls in particular are equipped with equal educational and skill-building opportunities, access to technology and digital innovations, and most importantly information and power to fully exercise their reproductive rights and choices.

The Indian government in 2021 had opposed coercion in family planning, and stated in several fora, including in Parliament, that it did not condone such policies, as they would prove to be “counter- productive.”

Andrea Wojnar, Representative UNFPA India and Country Director Bhutan on SWOP 2023, said, “As the national fertility rate falls below 2.1 (the replacement level), India is at a unique historical opportunity, witnessing a great demographic transition as a youthful nation, with a notable demographic diversity across states to convert the potential demographic dividend into economic benefits through additional investments in health, education, and quality jobs for young people - including targeted investments in women and girls. India’s demographic dividend can be further secured by incorporating the impact of megatrends such as climate change, urbanization, migration and ageing into policy initiatives.”

Besides, a survey with a total sample size of 1,007 was done in India, as part of the SWOP, and the findings suggest that population anxieties have seeped into large portions of the general public. "Yet, population numbers should not trigger anxiety or create alarm. Instead, they should be seen as a symbol of progress, development, and aspirations if individual rights and choices are being upheld," Andrea noted. 

Lack of awareness about abortion, contraception

Some data estimates suggest that India's population might have already surpassed China but till the official census is conducted a definitive number cannot be given. Poonam Muttreja said for any nation, the goal of a lower population growth rate requires a high contraceptive prevalence, which can only be achieved by strengthening the provision of family planning and sexual and reproductive health services, including access to abortion services.

According to data from the National Family Health Survey-5, 0.9 per cent of all pregnancies resulted in abortion in India. However, more abortions take place in urban areas - which is 4 per cent, compared to 2.5 per cent in rural areas, according to the latest NFHS data. In terms of economic background, 1.7 per cent of women from the lowest wealth quintile used abortion services compared to 3.2 per cent in the middle wealth quintile and 4.1 per cent in the highest wealth quintile, the data stated.

"What it means is that women who are less educated, or belong to poor and marginalised sections of society, are not able to use abortion services as well as their more affluent, more educated counterparts. This is partly due to the stigma that is associated with abortions and also the lack of access and availability of services to rural women," Muttreja said.

"Stigma forces women to seek services from quacks and untrained professionals which leads to maternal mortality and morbidity," she said. Even though India has very progressive abortion policies, according to a 2015 study published in the Lancet, 15.6 million abortions occur in India annually, 95 per cent of which are outside public health facilities.