“Unmet Need for Contraception”, by Shailaja Chandra

<b>The unmet demand for contraception is the highest in Uttar Pradesh, Bihar and Jharkhand. Together with Madhya Pradesh, these States produce the maximum underweight, stunted and wasted children born to under-aged mothers</b>

Were it not for the Hindi-belt States, India might well have been another country. Girl’s married before the legal age, high fecundity of adolescents, recurring childbirths and absence of birth spacing make tedious reading. But when the findings of the National Health Survey-3 are read alongside the Ministry of Human Resource and Development and National Population Commission data, a few surprises and some shocks emerge.

First, Orissa has crawled out of the BIMARU (now EAG) stranglehold. It has among the lowest annual growth rates (2001-2010) projected for the country — just a shade higher than Kerala and Tamil Nadu. As far as the age of marriage and adolescent fertility are concerned, Orissa is lower than Gujarat and Haryana. Female drop-out rates from classes’ I-X are better than the All-India average and far better than neighbours Assam and West Bengal. High infant mortality, however, pulls back other achievements.

Let’s move over to Himachal Pradesh. The female dropout rate from class I-X stands only slightly above Kerala. HP also has the lowest percentage of women married before 18 — far ahead of Kerala, Tamil Nadu or any other State. As a natural outcome the percentage of women that started childbearing before 19 was just 3 per cent compared with 27 per cent in Jharkhand and 25 per cent in Bihar and West Bengal. No wonder that the fertility rate of Himachal Pradesh is equal to that of Kerala. This also blasts the belief that only the Southern States have the commitment to propel population stabilisation.

Another shock is how poorly West Bengal performs when it comes to the age at which girls start childbearing. The State is at the level of Bihar on this index with 62 per cent of girls married before 18, belying lofty claims that women’s welfare has pervaded the proletariat. In terms of educational attainment, the class I-X female dropout rates are worse than even Madhya Pradesh.

When it comes to the use of contraceptives, Andhra Pradesh, Himachal Pradesh and Punjab come out the best. Predictably the unmet demand for contraception is the highest in Uttar Pradesh, Bihar and Jharkhand, with the gaps in contraceptive cover resulting in high fertility and appalling levels of maternal, infant and child mortality. Together with Madhya Pradesh these States also produce the maximum underweight, stunted and wasted children in India.

Ultimately, faster development cannot take place unless fertility rates come down much sooner. Much as education, electrification, safe drinking water and toilets are necessary, absence of these can hardly be an alibi for denying reproductive rights, now. Pushing up the age of marriage as exemplified by Himachal Pradesh is a single achievable goal which can make the biggest difference. If we could simply ensure that girls do not get married before the legal age of marriage, up to 3.4 million births each year could be averted. That is 12 per cent of the total annual births in the country. Is it too much to ask Governments to ensure that marriages are stopped before the legal age? The road to population stabilisation need not be preceded by citing the education first approach all the time. Important as education is, Himachal Pradesh and Orissa have shown that other things too can make a difference to fertility and population growth.

The new Prohibition of Child Marriage Act 2006 was notified on 10th January 2007. With its enactment, the Child Marriage Restraint Act 1929 was repealed. Legally and administratively no law exists today to restrain or stop child marriages in States that have failed to notify the rules that accompany the Act. In effect no cognisance can be taken of those who marry off their daughters before 18.

According to information available with the Ministry of Women and Child Development, only Rajasthan, Karnataka, Kerala and Manipur have enacted the rules which are necessary for enforcing the Act. This despite a lapse of nearly 20 months and repeated exhortations to speed up the process. Chief Ministers need to be confronted with their perfunctory attitude to an all important subject which directly affects the health and well-being of mothers and children.

Laws apart, when did the Chief Ministers of Uttar Pradesh, Rajasthan, Madhya Pradesh, Bihar, Jharkhand, Chattisgargh, and West Bengal last review early marriages or order an audit into high levels of maternal mortality? What directions did they give? With what result?

None that is apparent from any published work.

Laws alone will not change the face of India. But in the absence of law and with more than 65 per cent of the girls in several States being married before 18 it is shocking that Chief Ministers can ignore what is happening.

A year ago on the World Population Day, 500 adolescents were brought to Delhi to be sensitised about population issues. It was a sad commentary on the prevailing situation when they stepped on the stage to castigate their Chief Ministers for incentivising more and more deliveries by offering saris and other goodies to reward every birth. If only Chief Ministers cared to listen to what the youth of this country seeks, election manifestos may start caring about fulfilling population goals and reproductive rights.

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