India has managed to significantly reduce teenage pregnancy over the past few years, which has resulted in a positive change in infant mortality rate as well as maternal mortality rate.
This article is part of the series – World Population Day.
In 2016, the United Nations Children’s Fund (UNICEF), together with the United Nations Population Fund (UNFPA), launched a global initiative to tackle child marriage in 12 countries where the practice was most prevalent: Bangladesh, Burkina Faso , Ethiopia, Ghana, India, Mozambique, Nepal, Niger, Sierra Leone, Uganda, Yemen and Zambia. The program aimed to achieve results for girls by aligning key stakeholders in education, child protection, social protection, social and behavior change, gender, health and other sectors. The UNFPA-UNICEF Global Program to End Child Marriage has worked to improve the capabilities of governments and non-governmental organizations, while promoting harmonized action and accountability.
We celebrate World Population Day on July 11, 2022, and the organizers — the United Nations (UN) — remind the world that the focus should be on people, not on people. It is unacceptable to reduce people to mere numbers that strip them of their humanity. Indeed, as UNFPA states, instead of making the numbers work for systems, it is necessary to make the systems work for the numbers by promoting the health and well-being of populations. There were calls during the pandemic that leaders with possible fertility changes urgently need to support women’s reproductive rights and choices.
It is in this broad context that a new report entitled “Childhood motherhood: The untold storyWas released by UNFPA on 27 June 2022, examining global trends in adolescent pregnancies using techniques that focus on the most vulnerable girls, such as mothers of children, girls with recurrent adolescent pregnancies, and births that occur dangerously rapidly in succession. Interestingly, the report noted that the decline in overall levels of adolescent labor in Central and Southern Asia was among the most dramatic of any world region and that these sharp declines were led by trends from India. As Graph 1 shows, the region’s average mother’s age at first birth, led by India’s decline in adolescent pregnancies, coincided with the world average over time. Along with India were countries that saw the most impressive declines were Bangladesh, Egypt, Eswatini, Indonesia and the Maldives.
Graph 1: Mother’s median age at first birth over time
This increase in the mother’s median age at birth in India is accompanied by an impressive decrease in the overall fertility rate. A look at the latest National Family Health Survey (2019-21) shows that compared to 3.4 in the mid-nineties, the total fertility rate is now just 2.0 children per woman, below the replacement level of fertility of 2.1 children per woman. The decline in rural fertility is even more impressive for the same period — from 3.7 to 2.1 children per woman (Chart 2). NFHS 1 to 5 are from 1992–93, 1998–99, 2005–06, 2015–16 and 2019–21, respectively.
Graph 2: Trends in fertility rate by location
This achievement seems even more impressive when we consider the fact that India faced a rapidly growing population in the 1960s, with a fertility rate of almost six children per woman. China reached replacement level fertility in the 1990s – mainly due to its controversial population controls, including the one-child norm. Interestingly, China is now staring at a future of underpopulation, shifting its population policies rapidly, and even adapting a three-child policy to boost incredibly low levels of current fertility. Although India may have been decades away from such policy U-turns due to its young population and what is known as ‘population momentum’, Indian demographers are now reportedly ‘arguing’ less about how frighteningly high its population could be and more about how frighteningly low it can go ‘.
In recent decades, India’s high rate of population growth has been driven by an early average age of marriage. However, the latest evidence from the National Family Health Survey 5 (2019-21) indicates that between NFHS 1 and NFHS 5, the largest decrease in fertility was among the age group 15-19, where the fertility rate decreased from 116 per 1,000. population up to 43 per 1 000 population (graph 3). The adolescent fertility rate varies greatly across Indian states and union areas – from 91 in Tripura to 2 in Ladakh and Lakshadweep.
Graph 3: The Great Depression: Trends in Adolescent Fertility in India
Among the relatively poor Empowered Action Group (EAG) states (Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Odisha, Rajasthan, Uttar Pradesh (UP) and Uttarakhand), Uttarakhand (19), Chhattisgarh (24) and UP (22)) has managed to bring adolescent fertility rates to unbelievably low levels, an achievement rarely celebrated in India. Graph 4 shows that, apart from Bihar, there has been across the board improvement in the EAG states over the past decade. At the same time, Chhattisgarh and UP are earning awards because they reduced adolescent fertility rates from very high levels in 2005-06 to levels of about half the Indian average, even better than most South Indian states.
Graph 4: Adolescent Fertility: Trends in the EAG States
Nevertheless, for India, it is only a battle that has been half won. Latest data indicates that 7 percent of Indian girls between the ages of 15–19 are already pregnant. Within this age cohort, 5 percent had a live birth and 2 percent were pregnant with their first child. Teenage pregnancy is higher in rural areas compared to urban areas. Eight percent of women in rural areas in the age group 15–19 have already started giving birth. The latest NFHS data suggest that the level of teenage pregnancy is declining with an increasing level of schooling. Data show that 18 percent of girls between the ages of 15–19 with no schooling have already started giving birth, compared to only 4 percent among girls who had 12 or more years of schooling. Pregnancies among girls aged 15–19 also decrease with the level of prosperity. Only 2 percent of teenage girls in the highest wealth quintile started giving birth, compared to 10 percent of teenage girls in the lowest wealth quintile. Adivasi and Muslim girls have relatively higher rates of teenage pregnancies.
Graph 5: Teenage motherhood by state / union area (NFHS 5): Percentage of pregnant girls between the ages of 15-19
Graph 5 demonstrates the relative effectiveness of the fight against adolescent pregnancies in Indian states. As is clear, states like Uttarakhand, UP and Chhattisgarh of the EAG group were able to keep the percentage of girls who gave birth or were pregnant with their first child in the age group 15-19 low. There is ample evidence that teenage pregnancies lead to malnutrition in the baby and have acute negative impacts on the mother’s health, leading to adverse health outcomes for the child and the mother. Undoubtedly, the dramatic decline in adolescent fertility rates achieved by India, particularly by many EAG states, has contributed greatly to the rapid decline in infant mortality rate (IMR) over the years (Chart 6), and also to the improvement in maternal mortality indicators.
Graph 6: Infant mortality rate over NFHS rounds
UNICEF research shows that the girls who are most at risk of child marriage are often the ones who are most difficult to reach, which explains why many states are in such positions as indicated by Graph 5. Girls who marry early come mainly from poor families, marginalized groups, or rural areas. It is also known that they are more likely to be out of school than their happier peers, constantly at risk of pregnancy and deprived of the opportunity to realize their true potential. This is exactly why the fight against adolescent pregnancies and child marriages is a fight that India needs to win and win fast. On this World Population Day, India must renew its promise against adolescent pregnancies and create cross-learning platforms where other states with similar socio-economic realities can learn from top performers like UP and Chhattisgarh about their respective strategies that have worked in their quest for success. – brings down adolescent fertility from very high levels just a decade and a half ago.