Determinants of Fertility Decline in India An Analysis SWP-699 K. C. Zachariah Sulekha Patel WORLD BANK STAFF WORKING PAPERS Number 699 POPULATION AND DEVELOPMENT SERIES Number 24 SFCTOltAL LIDRARY rNTERNATIONAL BANX RECONsTRUC-oN AND DEVELOPMENT FEB 2 1 185 02 . ( <)~~~~44- 01 i HB 1049 . Z33 1 j45 1984 ***HB1049.Z331984 Determinants of fertility decline in India an analysis / SLC024592 WORLD BANK STAFF WORKING PAPERS Number 699 POPULATION AND DEVELOPMENT SERIES Number 24 Determinants of Fertility Decline in India An Analysis K. C. Zachariah Sulekha Patel The World Bank Washington, D C., U.S.A. Copyright () 1984 The International Bank for Reconstruction and Development/THE WORLD BANK 1818 H Street, N.W Washington, D.C. 20433, U.S.A. All rights reserved Manufactured in the United States of America First printing December 1984 This is a working document published informally by the World Bank. 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Zachariah is senior demographer and Sulekha Patel a research assistant in the Population, Health, and Nutrition Department of the World Bank. Library of Congress Cataloging in Publication Data Zachariah, K. C. (Kunniparampil Curien), 1924- Determinants of fertility decline in India. (World Bank staff working papers ; no. 699. Population and development series ; no. 24) Includes bibliographical references. 1. Fertility, Human--India. 2. Birth control--India. I. Patel, Sulekha. II. Title. III. Series: World Bank staff working papers ; no. 699. IV. Series: World Bank staff working papers. Population and development series no. 24. HB1049.Z33 1984 304.6'32'0954 84-25773 ISBN 0-8213-0456-9 l+13 ( V0% V&r FOREWORD This paper is one in a special series of World Bank Staff Working Papers on population change and development. Prepared as background papers for the World Development Report 1984, they provide more detailed treatment and documentation of the issues dealt with in Part II of the Report. The papers cover a range of topics, including the effects of population growth and change on economic development, the determinants of fertility and mortality, the links between population growth and internal and international migration, and the management, financing, and effectiveness of family planning programs. They include several country and regional studies of fertility change and population policy. The background papers draw on a large number of published and unpublished studies of individual researchers, on Bank policy analysis and research, and on reports of other organizations working on population and development programs and issues. The papers are the work of individuals and the views and interpretations expressed in them do not necessarily coincide with the views and interpretations of the Report itself. I hope these detailed studies will supplement the World Development Report 1984 in furthering understanding of population and development issues among students and practitioners of development. Nancy Birdsall Staff Director World Development Report 1984 Some of the Papers in the Population and Development Series Ainsworth, Martha. Family Planning Programs: The Clients' Perspective. World Bank Staff Working Paper no. 676. Boulier, Bryan L. Evaluating Unmet Need for Contraception: Estimates for Thirty- six Developing Countries. World Bank Staff Working Paper no. 678. Bulatao, Rodolfo A. Expenditures on Population Programs in Developing Regions: Current Levels and Future Requirements. World Bank Staff Working Paper no. 679. Bulatao, Rodolfo A. Reducing Fertility in Developing Countries: A Review of Determinants and Policy Levers. World Bank Staff Working Paper no. 680. Bulatao, Rodolfo A. and Anne Elwan. Fertility and Mortality Transition in Developing Countries: Patterns, Projections, and Interdependence. World Bank Staff Working Paper no. 681. Cain, Mead. Women's Status and Fertility in Developing Countries: Son Preference and Economic Security. World Bank Staff Working Paper no. 682. Gwatkin, Davidson. Mortality Reduction, Fertility Decline, and Population Growth: Toward a More Relevant Assessment of Relationships Among Them. World Bank Staff Working Paper no. 686. Herz, Barbara. Official Development Assistance for Population Activities: A Review. World Bank Staff Working Paper no. 688. McNicoll, Geoffrey. Consequences of Rapid Population Growth: An Overview. World Bank Staff Working Paper no. 691. Merrick, Thomas W. Recent Fertility Declines in Brazil, Colombia, and Mexico. World Bank Staff Working Paper no. 692. Muscat, Robert and others. Rapid Population Growth and Human Carrying Capacity: Two Perspectives. World Bank Staff Working Paper no. 690. Sapir, Andre. Some Aspects of Population Growth, Trade, and Factor Mobility. World Bank Staff Working Paper no. 694. Standing, Guy. Population Mobility and Productive Relations: Demographic Links and Policy Evolution. World Bank Staff Working Paper no. 695. Tan, Jee-Peng and Michael Haines. Schooling and Demand for Children: Historical Perspectives. World Bank Staff Working Paper no. 697. Trussell, James and Anne R. Pebley. The Potential Impact of Changes in Fertility on Infant, Child, and Maternal Mortality. World Bank Staff Working Paper no. 698. Zachariah, K.C. and Sulekha Patel. Determinants of Fertility Decline in India: An Analysis. World Bank Staff Working Paper no. 699. Zachariah, K.C. The Anomoly of the Fertility Decline in India's Kerala State: A Field Investigation. World Bank Staff Working Paper no. 700. Abstract Indian fertility has declined by at least 25 percent in the last twenty years. The current total fertility rate is 4.8, which is lower than that in any other country at the same or a lower level of socioeconomic development, as measured by per capita income, infant mortality, female education, and the like. Since 1975, however, decline in the the birth rate has shown a tendency to stall. This is partly due to an emerging unfavorable age structure (increase in the proportion of women of childbearing age) and partly due to stagnation in the family planning acceptance rate. Nearly 90 percent of the fertility decline in the period 1961-81 can be accounted for by the increase in family planning practice, and the balance by an increase in the age at marriage. Although family planning practice can account for much of the fertility differences, family planning input variables--manpower, budget, etc.--were much less important than socioeconomic factors such as female education and children's health in explaining the practice of family planning. About 60 percent of the inter- state variation in family planning practice (and hence fertility decline) can be attributed to socioeconomic differences, 10 percent to differences in family planning inputs, and the remaining 30 percent to their interaction. Our interpretation of the extent, pattern, and socioeconomic correlates of fertility decline in India is that, in the changing socio- economic situation, the increase in the cost of bringing up children creates a situation in which a smaller family size is becoming an economic necessity to an increasing number of couples. The family planning program served not only this emerging demand for small families, but created additional demand for contraception through information and incentives. Condense Au cours des vingt dernieres ann6es, la fecondite a baiss6 d'au moins 25 % en Inde. Actuellement, le taux de fecondite totale est de 4,8, c'est-a-dire inferieur a celui de tout autre pays se situant au meme niveau que l'Inde ou a un niveau inferieur pour ce qui est du d6veloppement socioeconomique mesur6 d'apres le revenu par habitant, la mortalite infantile, l'6ducation des femmes, et autres criteres analogues. Toutefois, depuis 1975, ce flechissement du taux de natalit6 semble stoppe. Cela est da en partie a l'apparition d'une structure defavorable de la pyramide des ages (accroissement de la proportion des femmes en age de procreer) et en partie a la stagnation du taux d'acceptation du planning familial. Le declin de la fecondite qui s'observe au cours de la periode 1961-81 peut etre attribu6 pour pres de 90 % au d6veloppement de la pratique du planning familial et, pour le reste, au fait que le mariage est contract6 a un age plus avanc6. Si la pratique du planning familial explique en grande partie les differences de taux de f6condite, les variables du programme de planning familial - personnel, budget, etc. - ont contribu6 de facon beaucoup moins importante que les facteurs socioeconomiques tels que l'education des femmes et la sant6 des enfants a cette pratique. Les diff6rences entre Etats dans la pratique du planning familial (et par cons6quent dans la baisse de la fecondite) peuvent etre attribuees pour environ 60 % aux differences socioeconomiques, pour 10 % aux differences dans les variables du planning familial et pour les 30 % restants a l'interaction entre les unes et les autres. Notre interpretation de l'ampleur, des caracteristiques et des causes socioeconomiques du declin de la fecondite observ6 en Inde est que, dans une situation socioeconomique en 6volution, comme il devient de plus en plus coateux d'elever un enfant, un nombre croissant de couples se voient obliges pour des raisons economiques de limiter la taille de leur famille. Non seulement le programme de planning familial a permis de repondre a ce nouveau besoin de se contenter d'une petite famille, mais il a suscite, par le biais de l'information et des encouragements, un regain de la demande de contraception. Extracto La fecundidad en la India ha disminuido por lo menos en un 25% en los 6ltimos veinte anos. La tasa total de fecundidad es actualmente de 4,8, mas baja que la de cualquier otro pais de igual o menor nivel de desarrollo socioecon6mico, medido en funci6n del ingreso per capita, la mortalidad infantil, la educaci6n femenina y otros parametros similares. Sin embargo, desde 1975 la declinaci6n de la tasa de natalidad ha mostrado tendencia a detenerse. Esto se debe en parte al surgimiento de una desfa- vorable estructura de la poblaci6n por edades (aumento de la proporcion de mujeres en edad de procrear) y en parte al estancamiento de la tasa de aceptaci6n de la planificaci6n de la familia. Cerca del 90% de la disminuci6n de la fecundidad en el periodo de 1961-81 puede atribuirse al incremento en la practica de la planifica- ci6n de la familia y el resto a la elevaci6n de la edad para contraer matrimonio. Aunque a la planificaci6n familiar cabe achacar gran parte de las diferencias en cuanto a fecundidad, las variables de estos programas usadas como insumos --recursos humanos, presupuestos, etc.-- fueron mucho menos importantes que ciertos factores socioecon6micos, tales como la edu- caci6n de las mujeres y la salud infantil, para explicar la practica de la planificaci6n de la familia. Alrededor del 60% de la variaci6n interesta- tal en dicha practica (y, por ende, en la disminuci6n de la fecundidad) puede atribuirse a diferencias socioecon6micas, el 10% a diferencias en los insumos de planificaci6n de la familia y el 30% restante a la interac- ci6n de esos factores. Nuestra interpretaci6n del alcance, la configuraci6n y las caracteristicas socioecon6micas conexas de la disminuci6n de la fecundidad en la India es que, en las circunstancias socioecon6micas cambiantes, el aumento del costo de la crianza y la educaci6n de los hijos crea una situaci6n en la que el tener una familia mas reducida esta volvi6ndose una necesidad econ6mica para un numero cada vez mayor de parejas. El programa de planificaci6n de la familia no solamente fue de utilidad para atender esta naciente demanda de familias pequefias, sino que cre6 una demanda adi- cional de anticoncepci6n por medio de informaci6n e incentivos. Table of Contents Page Summary and Conclusions. * ... * xii I. Introduction . ....................................... 1 II. Determinants of Fertility Decline - A General Framework .................... ... .. .. . . ..... .... 2 III. Fertility Trend in India by States . ... ................... .4 IV. Proximate Determinants of Fertilityo . . 12 V. Socio-Economic Factors Related to Fertility Decline.oo .o.o. ........... o ....................... 25 Statistical Annex .................. .... .................... . . .. 35 List of Figures Figure 1 Crude Birth Rate, India 1971-1980. 5 Figure 2 Demographic Transitions, c. 1960-1980, India and Indonesia .13 List of Maps Map I Total Fertility Rate by States, 1978 .57 List of Tables Page Table 1 Decomposition of Birth Rate 1961-71 and 1971-81 ..................... ...........* *... 4 Table 2 Birth Rates and Total Fertility Rates, India, 1941-51 to 1981 ......****................ 6 Table 3 Birth Rates by States ................... * ....... 7 Table 4 Total Fertility Rates by States 1972, 1978 .*.....**....****........................ 8 Table 5 Mean Age at Marriage of Females .................... 15 Table 6 Proportion Married (Females) by Age, India ......... 16 Table 7 Effect of Nuptiality Changes on TFR, 1961-81 ............. ............................... 16 Table 8 Fertility Impact of Changes in Proportion Married, 1961-71 and 1971-81 ...................... 18 Table 9 Birth Rates According to SRS and Estimated Birth Rates on the Basis of Births Averted due to Family Planning Program 1971-72 to 1982-83 *... ..... ...........*................. 19 Table 10 Percent of Couples Effectively Protected, India, 1970-71 to 1981-82 . ................... 19 Table 11 Cumulative Sterilization, IUD Acceptance Rate and Percent of Couples Effectively Protected .*..e*........... .............*...***.......... 20 Table 12 Decline in the Birth Rate, Actual, and Estimated on the Basis of Percent of Couples Effectively Protected ...................... 21 Table 13 Fertility Impact of Official Family Planning Program, 1961-71 and 1971-81 ............. 22 Table 14 Family Planning and Nuptiality Factors in Fertility Decline . . . ......... ..o. .. .... ...... 23 Table 15 Distribution of Family Planning Acceptors by Age of Wife and Method, 1973-74 and 1980-81 -*ooo .... o .... o- ... *.. o...-....... 24 List of Tables (cont'd) Page Table 16 Average Age and Average Number of Living Children of Family Planning Acceptors .......... . .... 25 Table 17 Regression Analysis, Program Variables and Socio-economic Variables . ....................... 29 Table 18 Total Marital Fertility Rate by Educational Attainment of Mothers .... .............. 30 Table 19 Age Specific Marital Fertility by Education, 1978 .................................... 30 Table 20 Age Specific Marital Fertility by Level of Education and Urban-Rural Residence, 1972 ........ .. 31 Summary and Conclusions This paper is concerned with an analysis of the determinants of fertility decline in India. Inasmuch as facts about the extent and patterns of fertility trend in India are not well documented this paper also attempts to present available information on fertility trend at the national and state level. The Indian birth rate is now around 34 per 1,000 population and the total fertility rate (TFR) is about 4.8. Prior to 1950 the birth rate was about 45 and the TFR about 6.5. Thus, India has definitely experienced a fairly significant fertility decline in recent years; a decline of at least 25 percent in the last 20 years. Much of the decline in the birth rate took place before 1976. Since then, the birth rate has shown a tendency to stall. The factors underlying this stalling have also been analysed in this paper. All the Indian states have experienced some degree of fertility decline in recent years. The extent of the decline varied from as little as 4 to 5 points in the birth rate in some of the northern states to 15 to 18 points in some of the southern states. In 5 states, mostly in the south, with a combined population of 200 million, the birth rate has already declined below 30, but in 4 other states, mostly in the north, with a combined population of over 250 million, the rate is still only marginally below 40. Sustainable fertility decline of a significant magnitude is yet to begin in some of these north Indian states. Much of the fertility decline since 1960 could be accounted for by increase in contraceptive practice. The other proximate variables -- nuptiality, abortion, and lactation -- played relatively minor roles. The effect of increase in age at marriage or decrease in proportion married at younger ages, was partly offset by increase in age at widowhood or increase in proportion married at older ages. The effect of increase in the practice of abortion was counterbalanced by the effect of decrease in breast feeding or a decrease in the period of lactation infecundity period. Ignoring abortion and lactation for which needed data at the national level are not available, a rough calculation indicates that 90 percent of the fertility decline in India during 1971-81 was attributable to increase in contraceptive practice and the balance 10 percent to changes in nuptiality rates. The proportion of couples protected by the official family planning program increased by about 12 points during 1961-71 and 1971-81 and the TFR declined by 0.8 points in both the decades. The nuptiality factor had slightly larger influence in 1971-81 than in 1961-71, but inspite of this increase, its relative contribution to fertility decline was only about 10 percent. ,ii - - wiii - Nearly all the state-wise variation in fertility rate (91 percent) and in family planning practice rates (81 percent) can be explained by a few socio-economic variables and family planning program input variables. The socio-economic variables which had statistically significant association with fertility rates were female literacy (which accounts for 64 percent of the explained variance) infant mortality rate (16 percent of the variance) female agricultural wages (9 percent) and per capita cropped area (7 percent). Those which had significant association with family planning practice were: literacy rate of the state (49 percent of the explained variance) and per capita domestic product (15 percent of the variance). Female wages did not show a statistically significant association with family planning practice rate. On the whole, socio-economic variables have had a relatively larger effect on family planning practice rate than family planning input variables. A rough breakdown is: socio-economic variables 60 percent, family planning variables 10 percent, and the interaction between them 30 percent. The principal program variable was per capita expenditure on family welfare which accounted for about 24 percent of the explained variance of family planning practice rate. The stalling of the birth rate since 1975 is related to two factors. One is a demographic factor. Between 1961 and 1971 the changes in age-sex composition in India was conducive to a decline in the birth rate. However, between 1971 and 1981 this was no longer true. If the age-sex composition had remained unchanged, the decline in the birth rate would have been higher by 19 percent during 1971-81. Since the reversal took place between these decades, its effect would have to be much higher in the latter half of the decade (i.e., during 1976-81). Thus, the full effect of the decline in fertility rate is not translated into birth rate in this period. A second factor involved in the stalled birth rate is the stalling of the contraceptive acceptance rate. Between 1971 and 1976 the proportion of couples effectively protected by the official program increased by 13 points, but between 1976 and 1981 the proportion hardly changed at all. The reasons behind the stalled contraceptive practice rate are likely to be both demand and supply related. There is little that can be done to reverse the demographic trend. The proportion of women in the reproductive ages is likely to increase for several more decades. However, the problem of stagnation in family planning acceptance rate is amenable to policy interventions. Our analysis has indicated that family planning is a feasible option to reduce fertility in the Indian setting. For about 200 million people living in 5 separate states, the fertility has declined to relatively low levels and for these states the prospects of a replacement level fertility by the year 2000 is within easy reach. The analysis has also indicated that inspite of the dominant part played by the family planning program as a means of fertility reduction, socio-economic factors have been much more important than program input variables in explaining interstate variation in fertility rate and family planning use. Given the - xi)V - socio-economic conditions, the fertility level in India is relatively low, lower than that of the any other country in the world with the same or lower level of socio-economic development. Thus, it appears that a major requirement for a further increase in contraceptive prevalence rate in India is improvements in socio-economic conditions. This means principally further reduction in infant mortality rates and increase in female education especially in states such as Uttar Pradesh and Bihar, Rajastan and Madhya Pradesh, where the IMR is above 100 and female literacy rate is below 20 percent. The family planning program input variables examined in this study were too few to give any definite conclusion regarding the exact contribution of program variables in relation to that of socio-economic variables. Our estimate is likely to be on the low side. Other studies have indicated that family planning programs can be used and in fact used to reduce the desired family size and strengthen the demand for family planning services. What is important is to develop the right information and communication strategy. Marital status composition was not a factor in the stalled birth rate, as its contribution to the decline in birth rate was marginally higher in 1971-81 than in 1961-71. However, barely 10 percent of the fertility decline in India in 1971-81 was contributed by increase in age at marriage. At the present low average age at marriage of women in India, the potential for fertility reduction through increase in age at marriage is much larger. This is a means of fertility reduction which is very much untapped in most states of India and deserves as much attention and financial backing as the family planning program. I. Introduction The Indian birth rate is now around 34 per 1,000 population and the TFR is about 4.8.1/ Prior to 1950 the birth rate was about 45 and the TFR was about 6.5. Thius India has definitely experienced a fairly significant fertility decline in recent years. Recent data show that the decline in the birth rate is not continuing as fast as it did in the past; the rate has stalled somewhat at a level of about 34. Although such a stalling has been observed in a few other developing countries in recent years, it was not expected on the basis of historical experience of developed countries. In the past, at a level of 34, a birth rate usually declined rapidly. For example, international data on birth rates for the 195U's and 1960's show that there were few countries with birth rates in the. range of 30-34; most of the national birth rates were either above 35 or below 25.2/ The Indian birth rate is in this range, and therefore, it should have b7een declining more rapidly. Yet the decline is slow; the rate appears to have stalled. There appear to be some basic differences between the factors which moderated fertility in the 1950's and earlier, and those which seem to be operating in India and in some of the other developing countries at present. What are the factors which caused the Indian fertility to decrease in recent years? In what ways do the determinants of the recent fertility decline in India differ from those of other countries in earlier times? This paper is concerned mainly with these questions. The paper begins with a general framework for explaining fertil- ity trend in India. Inasmuch as this framework was developed largely on the basis of the work done by the author on determinants of fertility decline in Kerala,3/ this section gives a brief description of the Kerala framework of fertiTity decline and its relevance in the Indian context. The paper later proceeds to a description of fertility levels and trends by states in India, and relates the Indian experience in fertility decline with the world experience. This is followed by an analysis of the role of the family planning program and increase in age at marriage in the decline in fertility. The last section takes up the interstate variation and socio-economic differentials in fertility and family planning practices and examines the factors related to their differences in a multivariate context. 1/ The official estimate of 4.5 for 1978 is biased because of the higher representation of unmarried women in the sample. 2/ UN Population Bulletin No. 7, 1963. Table 1.2, p. 2 3/ K. C. Zachariah. The Anomaly of the Fertility Decline in Indian's Kerala State: A Field Investigation. WTorld Bank Staff Working Paper No. 700, October 1984. - 2 - II. Determinants of Fertility Decline - A General Framework In a recent reappraisal of theories of fertility decline, Ronald Freedman4/ has suggested that for less developed countries today, motivation for fertility decline can arise from fewer changes than those that characterized the West. Under modern conditions, ideas and aspiration for a different way of life are also important in motivating lower fertility. The concept and means of family limitation within marriage produce an independent effect on fertility decline, once motivation is present. The author's analysis of fertility decline in Kerala suggests that the concept and means of family planning have independent effects on fertility decline not only when motivation is present, but also when the motivation is weak or even absent. Official intervention in population matters is a relatively new phenomenon. This has altered somewhat the pattern of fertility decline and its relationship with socio-economic factors. In evaluating the determinants of fertility decline in India, it is necessary to take into consideration not only the socio-economic factors which are involved in demographic transition, but also this new element of official involvement and financial incentive for family planning practice. Emperical support for such a reappraisal of the demographic transition theory is given by the Kerala study. Kerala Framework of Fertility Decline5/ Kerala has experienced an unexpectedly rapid decline in fertility under seemingly unfavorable circumstances--low per capita income, low degree of urbanization, industrialization, etc. At the same time, the population is well-developed with respect to education and mortality decline, two very important factors in the classical transition theory. The theoretical framework assumed to explain fertility decline in Kerala includes not only these elements from the transition theory but also the new element of the influence of state policies and programs on fertility. The fertility decline in Kerala was assumed to be a result of historical developments as well as recent policy interventions. Historical developments eroded the economic value of inherited characteristics (caste, religion, etc.) and inherited wealth (land), and enhanced the economic value of personal characteristics (education and health). Fueled by inter-communal rivalry in developing human capital, the State experienced a sharp decline in mortality and an accelerated improvement in educational attainment. The low mortality conditions and high educational attainment provided the necessary milieu for a fertility decline. The low mortality enabled couples to attain their desired (surviving) family size with fewer children ever-born. The high educational attainment enabled parents to make rational decisions about 4/ Ronald Freedman. "Theories of Fertility Decline: A Keappraisal", Social Forces, 58(1):1-17, 1979. 5/ For an elaboration of the Kerala framework of fertility decline, see Zachariah, op.cit., pp. 230-243. - 3 - family size, taking into consideration mortality risks and their given socio-economic perspective; it enabled couples to utilize family planning services effectively and limit or postpone births as and when they feel desirable; it increased the cost of bringing up children as education became a necessity for economic survival, it increased the opportunity costs of women and reduced the economic benefits from children; and it increased the risk of unemployment especially at critical younger ages. While these long-term socio-economic changes produced the necessary milieu and caused the age at marriage to increase, the sharp decline in marital fertility was precipitated by more recent policy interventions--land reforms, agrarian reforms, and the official family planning program in particular. The land reforms and other redistributive policies operated on fertility in different ways. The economic realignment has caused some socio-economic groups to suffer loss of land, status, income, etc., with no hope of immediate recovery, forcing them to make demographic adjustments toward later marriages and fewer children. The increase in wages decreased the income of land owners, even those who have not lost any land, forcing them also to adopt fertility control. Wage increases boosted the cash income of female daily wage earners, raising the opportunity cost of their time spent in bringing up children. The increase in wages also reduced employment opportunities, forcing children out of the job market and making them economically less valuable. Even the hutment dwellers who undoubtedly gained by the land reforms and wage legislation began to feel the need for birth control, as their children found it impossible to obtain a place for a hut of their own. The official family planning program came at an opportune time to serve the manifest demand, strengthen the latent demand, and create new demand for birth control, especially among the poor. Applicability of Kerala Framework to other States of India The socio-economic situation in the other states is somewhat different from that in Kerala, and yet the fertility decline in these other states can also be explained in the same general framework, namely: - increase in cost of bringing up children in relation to the benefits from them; and - family planning education and services. In Kerala, the cost increase came about because of increase in the proportion of children surviving in a family, the economic necessity to invest in children's education and health, and through a series of policies related to land distribution, wages, etc. These changes are relevant in the other states also, but the degree of change and their relative importance vary significantly from state to state. It is our hypothesis that interstate variation in the extent of fertility change in recent years can be explained by the differences in the family planning program and in the changes in the socio-economic factors which determines the cost of bringing up children in these states. The principal among these - 4 - socio-economic factors are mortality, education, agricultural density, female wages, and land redistribution. III. Fertility Trend in India by States Fertility Trend in India. There is some uncertainty about the fertility level and trend in India. Recent data are more reliable and they indicate that the birth rate is about 34 and the total fertility rate is about 4.8. Working backwards on the basis of expected decline due to family planning program and changes in proportion married, an estimate of 6.5 can be taken as the TFR for India as a whole before 1960. These figures indicate a fertility decline of 26 percent in recent years. Substantial declines took place before and after 1971. Rough estimates are: a decline of 0.8 in TFR before 1971 (12%) and a decline of 0.9 during 1971-81 (16%). Since 1976 the decline in birth rate has slowed down. In fact, birth rate seems to have stalled (Table 2 and Figure 1), although the fertility rate continues to decline, but at a slower rate. An approximate decomposition of the decline in birth rate during 1961-71 and 1971-81 is given Table 1: Table 1: Decomposition of birth Rate 1961-71 and 1971-81 Factors 1961-71 1971-81 1961-81 1. Total decline: 4.0 (100)1/ 6.0 (100)1/ 10.0 (100)1/ 2. Due to age-sex compositional change: 2.14 (54) - 1.13 (-19) 1.01 (10) 3. Due to changes in marital status composition: 0.61 (15) 0.76 (+13) 1.37 (14) 4. (2) and (3) together: 2.75 (69) U 0.37 (-6) 2.38 (24) 5. Due to fertility reduction within marriage: 1.25 (31) 6.40 (106) 7.64 (76) 1/ 4 = 44 - 40; 6 = 40 - 34; 10 = 44 - 34. It shows that during 1961-81, the birth rate declined by about 10 points. Nearly three-fourths of this decline was due to declines in marital fertility. The age-sex composition contributed 10 percent to the decline and marital status composition 14 percent. Thus the three factors reinforced each other. - 5 - Figure I: Crude Birth Rate, India 1971-1980 C B R 40 3 9 - _ _ - _ _ _ _ 38 36 34, 32 r .7 7 7 7 7 7 7 7 7 Year 71 72 73 74 75 76 77 78 79 80 - 6 - Table 2. Birth Rates and Total Fertility Rates, India, 1941-51 to 1981 Birth Rate TFR Period Reported Correcteda/ Keported Correctedb/ 1941-51 39.9 43.0 1951-61 40.9 44.0 1961-71 41.1 41.1 1970 36.8 1971 3b.9 40.0 1972 36.9 38.6 5.17 5.75 1973 34.6 37.4 - 1974 34.5 36.4 4.88 1975 35.2 35.5 - 1976 34.4 34.9 4.68 1977 33.0 34.4 - 1978 33.3 34.1 4.50 4.90 1979 33.7 34.1 - 1980 33.7 34.1 1981 33.9 - 4.80c/ Sources: Reported: 1941-51 to 1961-71. Census of India estimates (reproduced from Visaria p. 10); 1970-1978 Sample Registration data (from Visaria p. 19 and 1979-81 from Sample Registration Bulletin XVI, (2) December 1982, p. 34. a/ SRS Bulletin, June 1983. b/ "Preliminary Estimates of Fertility Decline in India during the 1970's," A.K. Jain and A.L. Adlakha. c/ World Bank estimate. This was however not the case in the most recent decade. In 1971-81 changes in age-sex distribution was highly unfavorable to a decline in birth rate (i.e., the proportion of women in child bearing ages increased). Had there been no change in marital status distribution and marital fertility, the birth rate would have increased by 1.1 points because of the age-structure effect. On the other hand, in the earlier period, 1961-71, changes in age-sex composition were highly favorable to a decline in the birth rate. Had there been no change in the marital status and marital fertility the birth rate would still have declined by 2.1 points. The shift in the direction between 1961-71 and 1971-81 is very instructive. It shows that 1971-81 could be the beginning of a longer period in which increasing proportion of women in child bearing ages would tend to dampen the decline in the birth rate or make it increase even when fertility falls. The "age effect" has to be much stronger towards the end of the decade than in the beginning (evident from the change in the sign). This is one explanation of the stalling of the Indian birth rate since 1976 - 7 - However, this is not the only explanation. Although changes in marital status composition do not seem to have been a factor in the stalling, changes in the proportion of couples effectively protected by the official family planning program was a major factor. Between 1970-71 and 1976-77 the proportion of couples effectively protected increased by 13 points, but between 1976-77 and 1981-82 the proportion hardly changed at all (Table 10). Family planning use from non-official sources could have increased, and it is likely that marital fertility continued to decrease slightly even when the birth rate was stalling. Even otherwise, proportion married continued to decrease at younger ages and TFR experienced some decrease. Thus, increasing proportion of females in the prime fertile ages and the decreasing demand for family planning services are the principal factors underlying the stalling of the Indian birth rate since 1976. Fertility Trend by States The States are very heterogeneous with respect to levels and trends in the birth rate. Table 3 indicates that in five of the major states, the crude birth rate was below 30.1 These states are inhabited by 190 million people, more than the population of Indonesia. Such a significant decline among such a large population is worth noting while comparing the Indian family planning program with other countries in Asia. Ten years ago there was no state in India with a birth rate below 30, and twenty years ago there was none with a birth rate below 35. In comparison to these relatively successful states are several other states, six among the major ones, with a combined population of 314 million and a birth rate above 35 even in 1982. These states have also experienced some decline in the birth rate, but the effect of the family planning program was not large enough to make a major impact on the birth rate. Table 4 gives the reported fertility rates by states in 1972 and 1978 for urban and rural areas separately. These rates are not very accurate, but can be used for comparative purposes.6/ The heterogeneity shown by the birth rate is also evident in the fertility rate, both in the urban and rural areas. There are a few other sources of fertility data for inter-state comparison. These are from the 1971 and 1981 census. The principal indices are child-women ratio (children 5-9 years/women 20-49 years) and average number of children ever-born. On the basis of all these indices an assessment of the relative ranks of the various states are made with respect to (i) fertility level around 1980 (Column A below) and (ii) fertility decline during 1970-80 (Column B below). 6/ Some of these rates are clearly underestimates although the number of births used in the calculations are fairly accurate. The total marital fertility rates (TMFKs) are more reliable. Table 3. Birth Rates by States Crude blirth Rate per 1,U00 Population States Census SKS 1951-61 1961-71 1970-72 1979-81 Andra Pradesh 39.7 39.2 35.4 31.5 Assam 49.3 48.4 37.9 32.7 Bihar 43.4 41.9 40.9a/ 38.4 Gujarat 45.7 41.6 40.4 35.1 Haryana 44.2a/ 44.5 39.6 36.8 Jammu and Kashmir 42.2a/ 41.5 32.5 31.3 Karnataka 41.6 39.9 32.0 28.2 Kerala 38.9 37.5 31.3 26.2 Madhya Pradesh 43.2 46.6 39.2 37.4 Maharashtra 41.2 41.0 32.0 28.3 Orissa 40.4 41.3 35.8 31.8 Punjab 44.7 36.9 34.2 29.6 Rajasthan 42.7 42.7 41.1 36.8 Tamil Nadu 34.9 36.8 31.3 28.2 Uttar Pradesh 41.5 42.5 44.5 39.5 West Bengal 42.9 44.3 36.6a/ 31.5 India 41.7 41.2 37.2 33.2 a/ Estimated by author. Sources: 1951-61 and 1961-71: World Bank sources. 197U-72: Family Welfare Programme in India Yearbook, 1981-82, Government of India, New Delhi, Table B.5. 1979-81: Sample Registration Bulletin, Vol. XVI, No. 2, Dec. 1982. - 9 - Table 4. Total Fertility Rates by States, 1972, 1978 Urban Rural Combined States* 1972 1978 1972 1978 1972 I97 Andra Pradesh 4.5 2.7 4.8 4.1 4.7 3.8 Assam 3.7 2.8 5.3 4.0 5.2 3.9 Bihar 3.9 3.4 5.1 4.2 5.0 4.1 Gujarat 4.5 3.6 6.0 4.6 5.6 4.3 Haryana 4.7 3.2 7.0 4.6 6.6 4.3 Jammu and Kashmir 3.1 2.8 5.2 4.8 4.8 4.4 Karnataka 3.5 3.0 4.5 3.7 4.3 3.5 Keraia 3.6 2.3 4.2 2.8 4.1 2.7 Madhya Pradesh 4.4 3.8 6.2 5.3 5.9 5.0 Maharashtra 3.8 2.9 4.8 3.9 4.5 3.5 Orissa 4.0 3.5 4.7 4.3 4.6 4.2 Punjab 4.1 3.2 5.7 4.1 5.3 3.9 Rajasthan 5.4 3.9 6.4 5.5 6.2 5.2 Tamil Nadu 3.0 2.9 4.4 3.5 4.0 3.3 Uttar Pradesh 4.8 4.1 6.9 5.9 6.6 5.6 West Bengal 3.6a/ 2.5 4.5a/ 3.5 4.3a/ 3.2 * States with a population of 5 million or more in 1981. a/ Estimated by the author. Source: Vital Statistics Division, Office of the Registrar General. Levels, Trends and Differentials in Fertility, 1979. Ministry of Home Affairs, New Delhi, November 1981. - 10 - Column A Column B Fertility level from lowest Fertility Decline from highest to the highest to lowest 1. Kerala 1. Kerala 2. Tamil Nadu 2. Punjab 3. Maharashtra 3. West Bengal 4. Punjab 4. Gujarat 5. Andhra Pradesh 5. Maharashtra 6. Karnataka 6. Karnataka 7. West Bengal 7. Tamil Nadu 8. Gujarat 8. Andhra Pradesh 9. Orissa 9. Orissa 10. Bihar 10. Madhya Pradesh 11. Madhya Pradesh 11. Rajastan 12. Rajasthan 12. Bihar 13. Uttar Pradesh 13. Uttar Pradesh Geographic Patterns: Fertility rates and birth rates are lower in the southern States of India than in the northern States. In the north, the central States have in general higher fertility rates than those in the east or west (See Map 1). Assuming that fertility rates were not very much different in the past, the relatively lower rates in the south must imply a relatively more rapid fertility decline in these states. The path of fertility decline in India seems to follow the path of the south-west monsoon. The monsoon reaches India first in Kerala and then spreads northwards. On the way, it splits into two, covering northwest and northeast before reaching the north central states, namely, Uttar Pradesh, Bihar, Madhya Pradesh and Rajasthan. These states are yet to experience a good shower of fertility decline. Indian Fertility in the International Context Is a birth rate of 34 or a TFR of 4.8 too high, too low, or just average for a population like India's? In one respect, this is a very low level. When its development indicators are taken into consideration, there is no other country in the world with a fertility rate lower than India's (see Figures Al and A2 in the Annex). For example, at the level of income per capita in India, the expected TFR is 5.8, but the rate for India is 4.8. Similarly, for its literacy rate, the expected TFK is 6.6, and for its IMR the expected TFR is 6.1. Thus, with respect to each one of these socio-economic indicators, the Indian fertility rate is lower than expected on the basis of international or less developed country experience. - 11 - Not only that, at these levels of development, no other country has a lower fertility rate. For example, there is no country with an IMR higher than India's but fertility rate lower than India's. Similarly there is no country with a female literacy rate lower than India's, but with lower TFK. Thus, the Indian fertility rate is relatively low when its developmental indicators are taken into consideration. But this is hardly comforting for the Indian planners. The Indian population growth rate is too high from the point of the country's developmental needs. Fertility Trend in India and Indonesia One interesting comparison of Indian fertility trend is with the Indonesian rates. As is shown in Figure II, demographic transitions in India and Indonesia are practically indistinguishable. Fertility and mortality decline in Indonesia are no higher than those in India during the period 1960-8U, yet the family planning program in Indonesia is considered to be a "success" while that in India is referred to as a "failure". In this connection the following observation by McNicoll and Singarimbun7/ is worth quoting: It is a curious reflection on the capriciousness (or short attention span) of the international population community that, although Indonesia's demographic transition has roughly paralleled India's over the last two decades (with East Java's present fertility on a par with Kerala's or Tamil Nadu's), Indonesia is hailed as a population policy success story while India is typically portrayed as a failure. The demographic similarity may well extend to the bases for some of the regional fertility differentials: the likelihood that most other Indonesian provinces will soon reach East Java's present fertility level may be no greater than that of the northern states of India soon reaching Kerala's. The fact that the Indian fertility is not too high when its socio-economic development is taken into consideration, or that the Indian fertility decline has been as fast as that of Indonesia, which is hailed as a success story with respect to its family planning program, do not minimize the grave implications of the high fertility rate in India. The fertility rate and the consequent rate of population growth are too high from the point of the country's developmental needs. The Indian population is growing at an unprecedented 15 million per year, higher than in any other country in the world, including China. The Indian rate of population growth has not declined a bit even after 30 years of family planning: the growth rate in 1971-81 was the same as that in 1961-71. The demographic targets set by the Indian planners have rarely been reached or even approached. The births in 1984 would be 6.3 million more than the target (based on an actual rate of 34 and a target of 25 set in 1973). 7/ Fertility Decline in Indonesia. Analyses and Interpretation Committee on Population and Demography. Report No. 20. National Academy Press, Washington, D.C., 1983, p. 112. - 12 - The built-in momentum for population growth in India is such that even if the impossible target of a replacement level fertility is reached in 1984, the Indian population will grow Ly 80 percent. In reality, it is extremely difficult to contain the annual growth in India's population to under 16 million per year through the remaining years of the century. Thus, although the Indian fertility rate is not too high by international standards, and is lower than that in any other country of comparable socio-economic development, yet, because of the large base population, high population density, and the need to develop fast from its low level of development, the fertility rates in most states of India are much too high and the need to accelerate the decline in the birth rate is very urgent. For this purpose, we need to know what factors have caused the fertility to fall in India, what are the reasons why the birth rate has begun to stall, and what are the policy options at the disposal of the planners to accelerate fertility decline. The remaining sections of the paper are concerned with these questions. IV. Proximate Determinants of Fertility The principal proximate determinants of fertility are: a. proportion married; b. proportion using contraception; c. rate of induced abortion; and d. length of lactation infecundity period. Although all four are important, we will take up only two of them, namely, proportion married and proportion protected by contraception. Very little reliable information is available at the national level on the trend in either the number of induced abortions or the length of lactation ammenorrhea. It is likely that the abortion rate would have increased and lactation ammenorrhea decreased. The former would have decreased the fertility rate and the latter would have increased it. Thus, their net effect on fertility change is not likely to be very large. Age at Marriage and Proportion Married Age at marriage of females has been relatively very low in most states of India and one of the reasons for the high fertility in the country is that by the time a woman becomes old enough to recognize the problems of a large family, she already has too many children; there is little she can do at that stage. The mean age at marriage of females in 1961, 1971 and 1981 is given in Table 5. The singulate mean age at marriage for females was 18.3 years in 1981 and 17.2 years in 1971, representing an increase of nearly one year in the 10-year period. Similar increases took place in the previous decade. Thus, the age at marriage in India is increasing, but slowly. - ].3 - Figure II Demographic Transitions, c. 1960-1980 India and Indonesia 25 Death Rate 1960 India 20 15 Indonesia 1980 50 45 40 35 30 25 20 15 10 Birth Rate Source: Fertility Decline in Indonesia, Analysis and Interpretation Committee on Population and Demography. Report No. 20, National Academy Press, Washington, D.C. 1983. Figure 1, page 7. - 14 - Proportion Married For fertility trend, what matters most is the proportion of women married in each age group. These proportions change not only due to change in age at marriage, but also due to change in the age at which marriages are dissolved. Proportions married among females in 1961, 1971 and 1981 are given in Table 6. They decrease at younger ages, 15-19 years and 20-24 years, as a result of the increase in age at marriage. At the 1972 fertility rates, these decreases in proportion married should result in a decrease in TFR by 0.198 between 1961 and 1971, by 0.143 between 1971 and 1981 and by 0.341 between 1961 and 1981. This decrease was partly compensated by increases in proportion married at older ages which is a reflection of the increase in the age at marriage dissolution, especially through widowhood. The effect of this increase was an increase in the TFR by 0.119 during 1961-71, 0.047 during 1971-81 and 0.166 during 1961-81. The net effect of changes in age at marriage formation and marriage dissolution was a decrease in TFR of 0.079 during 1961-71, a decrease of 0.097 during 1971-81 and 0.176 during 1961-81 (Table 7). Thus, although increase in age at marriage has been a factor in the fertility decline in India in recent years, part of the effect of increase in age at marriage was nullified by the simultaneous increase in the age at widowhood leaving only a relatively small net decrease in fertility due to marital factors. Results of the calculations done at the state level is given in Table 8. The highest impact was in Punjab where the TFR had declined by 0.295 during 1961-71 and 0.207 during 1971-81 due to marriage factor alone. On the other hand, there are a number of other states, where the effect is very negligible. In 1971-81 Kerala shows the lowest effect. This can be explained in terms of the relatively very high average age at marriage in Kerala in 1971. Family Planning Program The Indian Family Welfare Program has an excellent evaluation program which collects and publishes service statistics. They include: i) family planning acceptors by methods; ii) cumulative acceptance of family planning by methods since the inception of the program; iii) couples currently and effectively protected by the various family planning methods; and iv) number of births averted. These statistics (primary and derived) are found to be quite accurate as ascertained by independent sample surveys in the various states by research organizations and by the Operations Research Group (ORG) at the national level. Selected family planning statistics for India and for the states are given in the Annex Tables Al to A7. - 15 - Table 5: Mean Age at Marriage of Females States 1961 1971 19/1 lY81 India 17.2 18.3 Andra Pradesh 15.4 16.4 16.2 17.3 Assam 18.6 16.5 - - Bihar 14.7 15.5 15.3 16.5 Gujarat 17.2 18.3 18.4 19.5 Haryana 15.8b/ 17.5b/ 16.6 17.9 Jammu and Kashmir 16.1 17.8 - - Karnataka 16.5 17.9 17.8 19.2 Kerala 20.1 20.9 21.0 21.9 Madhya Pradesh 14.3 15.2 15.0 16.5 Maharashtra 15.9 17.5 17.5 18.8 Orissa 16.5 17.2 17.3 19.0 Punjab 17.6 18.8 20.2 21.0 Rajasthan 14.6 15.4 15.1 16.1 Tamil Nadu 18.4 19.6 19.6 20.2 Uttar Pradesh 14.8 15.6 15.5 17.8 West Bengal 16.1 17.8 17.9 19.3 a/ Singulate Mean Age at Marriage b/ For Himachal Pradesh Sources: K.P. Goyal. "Shifts in Age at Marriage in India between 1961 and 1971", Demography India, Vol. 4 No. 2, Dec. 1975. SMAM, 1971 and 1981: Census of India, Paper 2 of 1983, Table 8. - 16 - Table 6. Proportion Married (Females) by Age, India Census Marital fertility Age 1961 1971 1981 1972 15-19 69.6 55.4 43.5 213 20-24 91.8 88.8 88.4 313 25-29 94.2 95.0 94.3 299 30-34 91.4 94.1 94.8 239 35-39 87.0 91.3 93.2 161 40-44 77.7 84.2 87.8 86 45-49 69.7 78.0 82.9 29 Source: India Census Reports, 1961, 1971 and 1981. 1972: Vital Statistics Division, Office of the Registrar General. Levels, Trends and Differentials in Fertility, 1979. Ministry ot Home Attairs, New Delhi, Nov. lY=1. Table 7: Effect of Nuptiality Changes on TFR, 1961-81 Decrease at Increase at Net Period younger ages older ages Change 1961-71 0.198 0.119 - 0.079 1971-81 0.143 0.047 - 0.097 1961-81 0.341 0.166 - 0.176 Source: Calculated from Table 6. - 17 - Since the inception of the program, 36.2 million sterilizations were performed (21.8 million vasectomies and 14.4 tubectomies); 9.5 million IUD's were inserted and a large number of condoms and pills were distributed. It is estimated that as a result of this program, 49.3 million births were averted and currently 24% of the eligible couples are effectively protected. An analysis done by the Director of Evaluation (Government of India) concluded that the births averted by the program could account for all the decline in the birth rates. If the pre-program birth rate was about 45.0, the estimated rate in 1981-82 on the basis of the births averted by the program would be 34.9 (1981-82); if the pre-program rate was only 42.5, the 1982-83 rate would be 32.8. The SRS rate for that year was 33.2. Thus, the program could account for almost the entire decline in the birth rate (Table 9). In 1971-72, the proportion of couples effectively protected was 12.4 (Table 10). The fertility impact of such protection in terms of birth rate was a reduction to a level of about 38.4 (Table 9). The effect on TFR was a reduction of 0.79 of a child per woman (Table 13). By 1981-82 the proportion of couples protected increased to 23.7. The additional reduction in the birth rate during 1971-81 due to family planning program was 3.5 points. The effect on TFR was 0.8 of a child per woman (Table 13). We have seen that the fertility effect of increase in age at marriage during 1971-81 was about 0.1. Thus, a rough estimate of the relative contribution of family planning in the fertility decline during 1971-81 would be 89%; the other 11% can be attributable to changes in proportion married. Interstate Variation As could be expected from the interstate variation in fertility rates, family planning performance varies considerbly from state to state (Table 11). By far the best performance was in Maharashtra where both the cumulative sterilization rate (492 per 1,000 married women aged 15-44) and percent of couples protected were the highest (37%). At the other extreme is Uttar Pradesh with a cumulative sterilization rate of only 128 per 1,000 married women aged 15-44 and a protection rate of 11%. The state-wise impact of the program on birth rate and TFR was not readily available in published reports. An approximate estimate was obtained using the regression relation between percent of couples protected in a year (in India) and the corresponding expected program birth rate. The results are shown in Table 12. In some states the observed decline in the birth rate was close to that estimated on the basis of couples protected (e.g. Kerala, Maharashtra) while in others they are very much different, (e.g., Assam). The disagreement between the two sets need not be due to errors in estimated births averted or in percent of couples protected. It can as well arise from errors in the birth rate, especially the rate in the earlier of the two years. This is likely to be the main reason for the large difference in Assam. - 18 - Table 8. Fertility Impact of Changes in Proportion Married. 1961-71 and 1971-81 Expected Change in TFK1/ Percent Decline TFK States 1961-71 1971-81 1961-71 1971-81 Andra Pradesh +.001 - .115 +0.02 - 1.98 Assam -.012 - -0.22 - Bihar +.077 -.112 +1.28 - 2.00 Gujarat -.166 - .187 -2.86 - 3.32 Haryana - - Jammu and Kashmir -.133 - -2.25 - Karnataka -.106 - .238 -1.87 - 4.29 Kerala -.122 - .111 -2.56 - 2.39 Madhya Pradesh +.031 - .182 +0.51 - 2.96 Maharashtra -.105 - .190 -1.81 - 3.34 Orissa +.061 - .326 +1.06 - 5.60 Punjab -.295* - .207 -5.21 - 3.86 Rajasthan +.022 - .112 +0.36 - 1.81 Tamil Nadu -.128 - .093 -2.39 - 1.78 Uttar Pradesh -.029 - .121 -U.47 - 1.97 West aengal -.191 - .229 -3.3b - 4.20 India -.080 - .098 -1.38 -1.71 1/ Keeping constant marital fertility and using observed proportion married. * Adjusted for areal changes between 1961 and 1971. The following fertility rates were used: 213, 313, 299, 239, 161, 86, 29. Source: World Bank Computations. - 19 - Table 9. Birth Rates According to SRS and Estimated Birth Rates on the Basis of Births Averted due to Family Planning Program 1971-72 to 1982-83 Estimated Birth Rate Year SRS if the Rates before the Program were: 42.3 45.0 1971-72 36.9 36.1 38.4 1972-73 36.6 35.4 37.6 1973-74 34.6 34.6 36.8 1974-75 34.5 34.5 36.7 1975-76 35.2 34.4 36.6 1976-77 34.4 33.6 35.7 1977-78 33.0 32.2 34.3 1978-79 33.3 32.6 34.7 1979-80 33.1 32.7 34.8 198U-81 33.3 32.8 34.9 1981-82 33.2 32.8 34.9 1982-83 - 32.5 34.6 Source: Family Welfare Program in India Year Book 1981-82, Government of India, New Delhi p. 8 Table 10. Percent of Couples Effectively Protected, India, 1970-71 to 1981-82 Year Sterilization IUD) CC Users Total 1970-71 8.1 1.4 1.1 10.6 1971-72 9.9 1.3 1.2 12.4 1972-73 12.3 1.1 1.2 14.7 1973-74 12.4 1.0 1.5 14.9 1974-75 12.8 1.0 1.2 15.0 1975-76 14.4 1.1 1.7 17.1 1976-77 20.9 1.1 1.8 23.7 1977-78 20.2 0.9 1.5 22.6 1978-79 19.9 0.9 1.6 22.4 1979-80 19.9 1.0 1.4 22.3 1980-81 20.0 1.0 1.7 22.7 1981-82 20.7 1.1 2.0 23.7 Source: Family Welfare Programme in India. Yearbook, 1981-82. Government of India, New Delhi, p. 107. - 20 - Table 11. Cumulative Sterilization, IUD Acceptance Rate. and Percent of Couples Effectively Protected Cumulative Steriliza- Cumulative IUD In- tion Rate per 1,000 sertion per 1,000 % of Couples State Married Women 15-44 in Married Women Effectively 1981 (Up to March '81) 15-44 in 1981 Protected Rate Rank Rate Rank Rate Rank Andhra Pradesh 359.4 6 33.2 17 27.2 7 Assam 239.1 13 67.5 1U 18.3 13 Bihar 166.8 15 33.4 16 12.2 15 Gujarat 407.8 3 75.6 9 34.9 2 Haryana 311.7 8 283.1 2 28.6 4 Himachal Pradesh 297.8 9 113.2 3 26.0 9 Jammu and Kashmir 138.0 16 93.4 7 10.8 17 Karnataka 289.6 11 86.1 8 24.7 10 Kerala 414.0 2 109.7 4 32.0 3 Madhya Pradesh 331.0 7 61.3 11 21.8 12 Maharashtra 491.6 1 48.1 14 36.7 1 Orissa 374.9 5 99.9 5 26.1 8 Punjab 273.1 12 305.6 1 27.4 6 Rajasthan 168.7 14 47.5 15 14.5 14 Tamil Nadu 404.1 4 53.4 12 27.7 5 Uttar Pradesh 128.0 17 97.8 6 11.3 16 West Bengal 294.8 10 52.7 13 24.4 11 India 297.9 78.2 23.7 Source: Family Welfare Programme in India. Yearbook 1981-82. Government of India, New Delhi, pp. 84-85, 108. Some of the rates were recalculated using 1981 census data on married women 15-44 years. - 21 - Table 12. Decline in the Birth Rate, Actual and Estimated on the 'asis Percent of Couples Effectively Protected Decline in Birth Rate Between 1951-61 and 1979-81 States Expected from X Difference of Couples Effec- (Actual- Actual,/ tively Protected2/ Expected) Andhra Pradesh 8.2 10.9 -z.7 Assam 16.6 8.6 +b.0 Bihar 5.0 7.0 -2.0 Gujarat 10.6 12.9 -2.3 Haryana 7.4 11.2 -3.8 Jammu and Kashmir 10.9 6.6 +4.3 Karnataka 13.4 10.2 +3.2 Kerala 12.7 12.1 +0.6 Madhya Pradesh 5.8 9.5 -3.7 Maharashtra 12.9 13.3 -0.4 Orissa 8.6 10.6 -2.U Punjab 15.1 10.9 +4.2 Rajasthan 5.9 7.6 -1.7 Tamil Nadu 6.7 11.0 -4.3 Uttar Pradesh 2.0 6.7 -4.7 West Bengal 11.4 10.1 +1.3 1/ From Table 2. 2/ Estimated using the regression 3.8 + 0.26 (percent effectively protected in 1980). The coefficients are estimated from the time-series for India as a whole (Tables 9 and 10). - 22 - The effect of family planning program performance on TFR was calculated using constant marital fertility by age group and decreasing the number of married women in each age group by the number of women protected by family planning methods. The results are given in Table 13. Table 13. Fertility Impact of Official Family Planning Program - 1961-71 and 1971-81 Decline in TFR Percent Decline TFR States 1961-71 1971-81 1961-71 1971-81 Andhra Pradesh 0.867 0.946 14.9 19.1 Assam 0.368 0.767 6.7 15.1 Bihar 0.396 0.458 6.5 8.0 Gujarat 1.091 1.234 19.4 27.2 Haryana 1.272 0.862 21.0 17.7 Jammu and Kashmir 0.488 0.224 8.4 4.2 Karnataka 0.581 1.002 10.5 20.6 Kerala 0.981 0.882 21.1 24.1 Madhya Pradesh 0.671 0.847 10.9 15.5 Maharashtra 1.125 1.160 19.8 25.9 Orissa 1.013 0.719 17.4 14.9 Punjab 1.416 0.391 26.4 9.9 Rajasthan 0.387 0.650 6.3 11.2 Tamil Nadu 0.882 0.789 16.8 18.2 Uttar Pradesh 0.417 0.387 6.8 6.8 West Bengal 0.556 0.979 10.2 20.0 INDIA 0.79 U.80 13.8 16.2 Note: Using constant age specific martial fertility, 1971 proportion married, 1971 and 1981 proportion of women protected, and 1981 age distribution of the protected women. Source: World Bank computations - 23 - In Gujarat, Maharashtra, and haryana the TFR decline by more than two children per woman during 1961-81. Next in order comes Kerala, Andhra Pradesh, Punjab and Karnataka. Fertility decline due to family planning was least in Uttar Pradesh, Jammu and Kashmir and Bihar. On the whole fertility decline since 1971 was slightly higher tiian that before 1971. This was true in all states except Haryana, and Jammu and Kashmir. Table 14 gives the combined effect of contraceptive practice and changes in marital status distribution. It also gives the contribution of family planning to the combined total. In 1971-81, the relative contribution of family planning varied from 89 percent in Andra Pradesh and Tamil Nadu to 65 percent in Punjab. Between the two periods 1961-71 and 1971-81, the percent contributea by family planning has decline in most states. This was not due to an absolute decline, but more due to a relatively larger increase in the contribution of the nuptiality factor. Table 14. Family Planning and Nuptiality Factors in Fertility Decline 1961-71 1971-81 Fertility Decline Fertility Decline States Total Due to F.P.(%) Total Due to F.P.(%) Andhra Pradesh .866 100 1.061 89 Assam .380 97 - - Bihar .319 124 .570 80 Gajarat 1.257 87 1.421 87 Jammu and Kashmir .621 79 - - Karnataka .687 85 1.240 81 Kerala 1.103 89 .993 89 Madhya Pradesh .640 105 1.029 82 Maharashtra 1.230 91 1.370 86 Orissa .952 106 1.045 69 Punjab 1.711 83 .598 65 Rajastan .365 106 .762 85 Tamil Nadu 1.010 87 .882 89 Uttar Pradesh .446 93 .508 76 West Bengal .747 74 1.208 81 Source: World Bank computations. - ?L - Characteristics of Family Planning Acceptors The effectiveness of family planning practice depends not only on the number of persons who practice, but also on the characteristics of the acceptors, especially their age distribution and parity. The majority of the family planning acceptors are in their thirties; nearly a third are in the age group 30-34 years. More than 80% of the acceptors are in the age group 25-39 years. The average age of acceptors was 31.6 in 1973-74 but decreased to 30.5 by 1980-81. Thus, over the years, the average age has decreased somewhat, indicating that the fertility impact of family planning acceptance has increased. By the time an average Indian woman reaches 30 to 35 years, she already has produced most of her children. The average number of living children at the time of acceptance was more than 3.5 for acceptors of sterilization. This is the average desired number of children as expressed by women in most of the surveys conducted in India in recent years. Thus when couples in India accept terminal methods of family planning they have achieved or surpassed their desired family size. Table 15. Distribution of Family Planning Acceptors by Age of Wife and Method, 1973-74 and 1980-81 Age Vasectomy Tubectomy IUD All Combined 73-74 80-81 73-74 80-81 73-74 80-81 73-74 80-81 15-19 - 1.6 0.3 0.2 0.5 2.9 4.4 1.4 1.0 20-25 10.6 10.5 7.0 12.7 18.0 28.4 11.2 13.6 25-29 21.2 29.4 30.5 36.2 30.8 34.0 27.7 33.8 30-34 30.9 33.0 36.3 32.0 29.6 21.7 32.7 31.6 35-39 22.6 2U.1 20.7 15.4 14.5 9.3 19.5 15.9 40-44 11.8 6.4 5.1 3.2 3.6 2.2 6.7 3.8 45-49 1.3 0.3 0.3 0.1 0.6 0.0 .8 0.3 1100.0 00.0 100.0 100.0 100.0 100.0 100.0 100.0 Avg. Age 32.7 31.6 31.4 30.4 29.4 28.0 31.6 30.5 Source: Family Welfare Programme in India. Yearbook, 1981-82 Government of India, New Delhi, p. 119. - 25 - Table 16. Average Age and Average Number ot Living Children of Family Planning Acceptors Avg. Age (Years) Avg. No. of Living Children Year = _ Vasectomy Tubectomy IUD Vasectomy Tubectomy IUD 1973-74 32.7 31.4 29.4 74-75 32.8 31.8 29.8 75-76 32.8 31.8 29.3 76-77 33.1 31.2 28.8 77-78 32.5 30.1 28.1 3.1 3.5 2.6 78-79 32.4 30.4 28.3 3.4 3.7 2.8 79-80 31.9 30.4 28.2 3.5 3.7 2.7 80-81 31.6 30.4 28.0 3.5 3.7 2.6 Source: Family Welfare Programme in India. Yearbook, 1981-82. Government of India, New Delhi, pp. 119, 123 V. Socio-Economic Factors Related to Fertility Decline The previous section has shown that much of the fertility decline in India in recent years (as much as 89% in 1971-81) was due to the increased contraceptive practice. States which have shown a high accep- tance rate have experienced high fertility decline also. As a result, the factors underlying fertilty decline in India are to a large extent the factors which determine contraceptive practice. In this section, there- fore, we begin with an analysis of the factors related to the interstate differences in family planning practice. Family Planning Family planning acceptance rate varies considerably by socio-economic factors. It is higher in the urban areas than in the rural areas, higher among the Hindus than among the Muslims, etc. Factors related to family planning use are analysed in a multivariate context using two measures of family planning performance. They are: i. percent of couples effectively protected, 1981-82 ii. cumulative equivalent sterilization up to 1982 per 10UU population - 26 - A simple regression between percent of couples effectively protected in 1981-82 and program variables indicated that expenditure on family welfare in 1981 can explain 32 percent of the variance. Other input variables are highly correlated with expenditure and did not add much to the total variance explained. Dependent variable: percent couples effectively protected in 1981-82 Independent Variables B F Ratio R2 1. Expenditure on F.W. (1980-81) per capita +.636 6.4 32.1 2. Field workers (1981-82) per capita -.418 0.4 2.0 TOTAL 34.1 When socio-economic variables alone were used in the regression, the total explained variance increased to 74.0 percent. The variables which had statistically significant association are: - female literacy - per capita domestic product of the state - female agricultural wages Additional variables added little to the total explained variance. The results of the regression are shown below: Dependent variable: percent couples effectively protected in 1981-82 Independent Variables b F Ratio K2 1. Female literacy rate 1971 +.67b 17.0 48.0 2. Per capita domestic product 1970-71 +.376 5.7 12.4 3. Female agricultural wages 74-75 -.391 6.4 13.6 4. Per capita cropped area 197U-71 +.1409 0.5 0.0 TOTAL 74.0 Female literacy has the highest explanatory power. The association is positive; that is, the higher the literacy rate in a state the higher is its proportion of couples effectively protected. There is a similar relationship with the per capita domestic product of the state. In the conceptual framework, we put forth the hypothesis that one of the reasons why women accept family planning is because their wages have gone up and therefore their opportunity cost has also increased. We should therefore expect a positive association between wages and family planning acceptance. The data shows the opposite pattern; there is a negative relationship between the proportion of couples effectively protected and female agricultural wages. - 27 - When family planning program variables and socio-economic variables are both introduced in the regression, the total variance explained was 83.5. Taking all the three analyses together, we can draw the following conclusions: - Socio-economic variables have a relatively higher impact on the use of family planning methods. The independent contribution of socio-economic variables was 59 percent of the explained variance of 83.5 percent. - Family planning expenditure has a statistically significant independent effect on family planning use. Their independent contribution was 11 percent of the explained variance. - The interaction between socio-economic variables and family planning variables was quite substantial, as much as 3) percent of the explained variance. Cumulative Sterilization Rate The cumulative sterilization rate is a fairly good index of the overall effectiveness of the program from its very beginning. This rate is regressed against program and socio-economic variables (average for the decade 1971-81). The conclusions are more or less the same. Among the program variables, expenditure on family welfare (per capita) is the one which has the highest correlation. All the other variables are highly correlated to the expenditure variable. Among the socio-economic variables three showed statistically significant association. They are the same (dates different) as those which showed significant association with proportion of couples effectively protected, namely: - average literacy rate, 1971-81 - average domestic product per capita, 1971-81 - average female agricultural wages 1964-74 The results of the regression are shown in Table 17. This table also shows that socio-economic variables played a more significant role than the family planning input variables. An approximate descomposition is: socio-economic variables 54 percent, family planning variables 15 percent, and interaction between socio-economic and family planning variables 31 percent. Fertility Although much of the fertility trend and differentials could be accounted for by the family planning program acceptance rate, since the latter is highly associated with socio-economic conditions, we should expect statistically significant relationships between fertility and socio-economic variables. In the conceptual framework described earlier, the principal socio-economic variables enumerated are mortality, education, - 28 - agricultural density, female wages and land redistribution. We have no useable data on land redistribution. We shall take up other factors one by one and examine how they are related to fertility level and trend. We will begin with a discussion of education. Education In general, educated women have fewer children than the illiterate. The lndian data support this negative relationship between fertility and years of schooling as shown in Tables 18, 19 and 20. In 1972, the difference in TFR between the least educated and the most-educated was 1.8 in urban areas and 1.9 in rural areas. By 1978, these differences had decreased to U.92 in urban areas and 0.81 in rural areas. Fertility decline in India during 1972-78 was stronger among the illiterate women than among the matriculates. Annex tables A.11 and A.12 give similar relationships at the state level. In all the states both in rural and urban areas there is a general negative relationship between years of schooling and the level of fertility. There are, however, a tew breaks in the regularity of the pattern. In a few instances, the marital fertility among the illiterates is lower than that among the literates with less than primary education, e.g., Assam, Bihar, Orissa, Uttar Pradesh, Karnataka. Similarly, in a few cases, women with primary education (less than matriculate) have higher fertility than women with less than primary education, e.g. Gujarat, Punjab, Haryana, Karnataka and Kerala. On the whole, such irregularities are exceptions. One reason for the observed higher fertility among women with less than primary education compared to the illiterate is the deficiency of the data (illiterates under-reporting births more than the literates). But this need not be the case always. The fertility rate of literates or those with primary education could as well be higher than those of the illiterates. Such patterns are observed in other studies in India and elsewhere. The negative relationship between fertility and education is not evident in all age specific fertility rates, but is confined to ages above 30 years (Table 19 and 20) . At younger ages, the fertility of more educated women is even higher, due evidently to their higher age at marriage and shorter duration of marriage. Regression Analyses Macro-analysis of the relationship between educational attainment and fertility at the state level using regression technique gives statistically significant negative relationship. The 1978 TFR and literacy rate of 1971 gives a zero-order correlation coefficient of -.759 which is statistically significant. When controlled for other variables, the total variance explained by the regression was 90.5 of which 57.5 (63%) was explained by literacy. The other variables which showed significant association were per capita female agricultural wages, infant mortality, and agricultural density (per capita cropped area). Table 17. Regression Analysis with Program Variables and Socio-Economic Variables Dependent variable: cumulative equivalent sterilization rate up to 1982 Regression No. Independent Variables I II III B R2 B K2 B RZ 1. Average per capita expendi- ture on family welfare .8673* 33.1 .582* 18.9 2. Average no. of service points per capita -.314 3.7 -.555 3.7 3. Average no. of worker in family welfare program -.048 U.1 .219 1.6 4. Average literacy rate .566* 38.9 .534* 38.9 5. Average domestic product per capita .455* 17.5 .387* 12.3 6. Average female agricultural wages -.354* 11.6 -.370 4.8 TUTAL 36.9 b8.0 80.2 Note: * Statistically significant at 5% level. A blank space indicates that the variable was not included. - 30 - Table 18: Total Marital Fertility Rate by Educational Attainment of Mothers Educational Level Rural Urban Rural Urban 1972 1978 Illiterates 6.9 6.3 5.5 4.9 Literates, below primary 7.1 5.0 5.0 4.5 Primary, below matriculate 7.1 5.0 4.9 4.2 Matriculates 5.0 4.5 4.7 4.0 Source: 1972: Vital Statistics Division. Fertility Differentials in India, 1972, Ministry of home Affairs, New Delhi, India, Table 7. 1978: Vital Statistics Division, Office of the Registrar General. Levels, Trends and Differentials in Fertility 1979, Ministry of Home Affairs, New Delhi, p. 7. Table 19: Age Specific Marital Fertility by Education, 1978 &awal Urban Age illiterate literate Primary Maltriculate illiterate Literate Primary Matriculate 15-19 175 176 179 207 185 205 211 218 20-24 268 277 294 262 276 269 297 271 25-29 248 223 236 214 219 203 188 195 30-34 188 146 158 132 154 122 97 76 35-39 126 109 8U 54 98 67 37 36 40-44 64 45 27 53 42 19 9 5 45-49 27 19 7 14 15 8 4 2 Source: Vital Statistics Division, Office of the Registrar General. levels Trends and Differentials in Fertility, 1979. Ministry of Home Affairs, New Delhi, p. 16. - 31 - Table 20. Age Specific Marital Fertility by Level of Education and Urban-Kural Residence. 197Z Rural Urban Literate Metric Literate 1Metric Age Illiterate Below or Illiterate but below or Metric Above Metric Above 15-19 214 228 128 218 227 211 20-24 3U6 351 300 296 330 302 24-29 303 315 445 254 286 239 30-34 252 228 115 223 169 102 35-39 173 146 25 150 94 36 40-44 95 88 2 71 24 10 45-49 32 65 0 81 10 0 TMFR 6.9 7.1 5.0. 6.3 5.0 4.5 Source: Vital Statistics Division, Fertility Differentials in India, 1972, Ministry of Home Affairs, New Delhi, Table 8. Literacy was also regressed against decline in TFK between 1972 and 1978. The zero-order correlation was -0.279 which was not statistically significant. When all the variables were included in the regression, the total variance explained was 63.1 of which only 0.08 was explained by literacy. None of the regression coefficients was significant. Thus, although fertility level is closely associated with literacy, recent change is not very much related to the literacy level of the state. Dependent Variable Total Fertility Rate, 1978 Independent Variables B F. Ratio R2 Female Literacy, 1971 -.439 10.1 .58 Infant Mortality Kate 1971 .542 16.7 .15 Female Agricultural Wages, 1974-75 .403 8.5 .10 Per Capita Cropped Area 1970-71 .375 7.7 .06 Per Capita Net Domestic Product 1970-71 -.230 1.8 .02 Percent Urban, 1971 .094 0.3 .00 TOTAL 0.91 - 32 - Mortality. Mortality decline, especially infant and child mortality decline, has a depressing effect on fertility in more ways than one: - through the biological effect on interval between births; and - through behavioral effect prompted by increase in the proportion of children surviving and consequent pressure on household resources. Statewise data on IMR in 1978 indicates that states with higher IMR have, on the whole, a higher fertility rate also. Both in the rural and urban areas, lower IMRs are associated with lower TFRs. Average TFR IMK Rural Urban <125 5.0 3.7 100-125 4.0 3.0 >100 3.5 2.9 Regressions based on statewise data indicate a zero-order correlation of +0.7U9, confirming the results from the cross-tabulation. When other variables were introduced, the regression coefficient became +0.542. IM accounted for 16% of the total explained variance. As in the case of literacy, the association between IMR and fertility decline was weaker than that between IMR and fertility level. The zero-order correlation was +0.194 and the partial regression was -0.191. None of the regression coefficients was statistically significant. IMR and literacy rate are highly correlated (-.491). When IMR and literacy are introduced in a step-wise regression, the regression coefficients of literacy and IMR remained statistically significant. The total variance explained by these two variables was 72.3. Both the coefficient and the F ratio of literacy were higher. While literacy has both a direct effect on fertility and an indirect effect through IMR, the latter's influence on fertility through literacy cannot be that important. A similar analysis conducted on change in fertility during the period 1972-78 indicated that neither literacy nor IMR is statistically significant. Female Wages. In the conceptual framework described earlier, employment of females and their wage rates are important factors which determine fertility through a woman's opportunity cost and her status in the household. The higher the average female wages, the lower should be the fertility rate. - 33 - The zero-order correlation between the 1978 TFR and female agricultural wages was -0.085 and that between change in TFR (1972-78) and agricultural wages was -0.531. The relationship between TFR in 1978 and female agricultural wages was not statistically significant. However, when other socio-economic variables were introduced the relationship became significant with a B-coefficient of +0.4025 and an F ratio of 8.5. However, the sign was not in the expected direction. States with higher female wages tend to have higher fertility. A similar conclusion was reached when the relation between female wages and family planning practice was analysed. As mentioned above, the zero-order correlation between fertility decline (1972-78) and female agricultural wages was -0.531 which was statistically significant. This again is contrary to our hypothesis of a faster decline in fertility where the agricultural wages are higher. However, when other variables are introduced the statistical significance disappears. Thus, the data do not support the hypothesis that increased female agricultural wages have played a role in the recent fertility decline. Other Variables The zero-order correlation coefficient between per capita cropped area and the 1978 TFR was positive (0.537) and statistically significant, and remains significant when other socio-economic variables are introduced in the equation. In the case of per capita net domestic product, neither the zero-order correlation nor the partial regression was statistically significant. Thus the empirical analysis supports only part of our hypothesis. On the basis of our conceptual framework we were expecting a strong positive association between education and family planning use, a strong negative association between education and fertility rate. This is supported out by the state-wise data as well as other micro-studies in India. We were also expecting a strong negative association between infant mortality and fertility and strong negative relationship between mortality and family planning use. The data support the negative association between fertility and IMR, but that with family planning is very weak. The state-wise data also support the hypothesis regarding a positive association between agricultural density and fertility. Contrary to our expectation, female agricultural wages in a state were negatively related to family planning use. Figure A.I. Total Fertility and Adult Literacy Rate, All LDCs 17 75 2 3 25 '28 75 34 25 39 75 45 25 50 75 56 25 6 1. 75 67 .25 7 004 I I + 7 00 6 GO60 6.60 6 20 +*II 6.20 I ~~~~~~~I 2 5 80+ I '5.80 - I - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - r 5 40+ 5 40 2 5.00 I +5.00 LL 4.60 411+4.60 ----------------------------------------------------------- o 4 20 + II+ 4.20 3 80 +II 3.80 3.40 *Ij+3.40 3.00 +I 3.00 Figure A.2. Total Fertility and Infant Mortality Rate, All LDCs 78 75 86 25 93 75 101 25 108 75 116 25 123 75 131 25 138.75 146.25 4 - -+ - - +-- - - - - -+ f - -_ + - _ -- ---+ --- --_ -- ---+ -- ---_ + ---- -- ---- -_ _+ ----- 7.00 4 *1 1 + 7.00 I I 1 . , * I I . I . I I I . ,1 * 2 1 I I I I 6 55 + I I + 6.55 I I . .. I * I F I I . I I I . I I 6.10 4 * I * I * * * * .+ 6.10 I .I I . * I I I 1 2 1 I I . I I 5 65 1 I + 5.65 _ ~~I I II ir ~ ~ ~~ ~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~* W I . I -I- F 1I 1. 1 I 5 20 , 1 , I + 5.20 I . I I I _ I ~~~ ~ ~~~~~I * I I 4 75 + I I +n LL zY ~I I I I W ~~I .I I I IL ~I I I I 4 30 t +4.30 4t I---- ------------------------ ------------------------------------__ ----_______--- --- _____________-I 0 3.85 + I I + 3.85 3 40 + I I + 3.40 2.95 1 I + 2.95 I I I I .e 2 50 + I I + 2.50 INW$F T M oftALI-" PAU. e8O. - 36 - Annex Table A.1. Family Planntng Acceptors by Methods - All India (Since 1956) (In '000) Equivalent Year Sterilizations I.U.D. Insertlons Equlvalent User Total Acceptors Sterilizations 1 2 3 4 5 6 1956 7 - - 7 7 1957 14 - - 14 14 1958 25 - - 25 25 1959 42 - - 42 42 1960 64 - - 64 64 1961 105 - - 105 105 1962 158 - - 158 158 1963 170 (36.4) - 298 (63.0) 468 (100.0) 187 1964 270 (38.0) - 439 (62.0) 709 (100.0) 294 January 1965 to March 1966 671 (32.5) 813 (39.3) 582 (28.2) 2,066 (100.0) 974 1966-67 887 (39.2) 910 (40.2) 465 (20.6) 2,262 (100.0) 1,216 1967-68 1,840 (61.7) 669 (22.4) 475 (15.9) 2,984 (100.0) 2,089 1968-69 1,665 (53.60 479 (15.4) 961 (31.0) 3,105 (100.0) 1,378 1969-70 1,422 (41.9) 459 (13.5) 1,509 (44.6) 3,390 (100.0) 1,659 1970-71 1,330 (35.3) 476 (12.6) a/1,963 (52.1) 3,769 (100.0) 1,598 1971-72 2,187 (43.5) 488 (9.7) T/2,354 (46.8) 5,029 (100.0) 2,481 1972-73 3,122 (53.2) 355 (6.0) T/2,398 (40.8) 5,875 (100.0) 3,373 1973-74 942 (21.8) 372 (8.6) 7/3,010 (69.6) 4,324 (100.0) 1,233 1974-75 1,354 (31.4) 433 (10.1) T/2,521 (58.5) 4,308 (100.0) 1,638 1975-76 2,669 (39.2) 607 (8.9) Tr/3,528 (51.9)b/ 6,804 (100.0) 3,068 1976-77 8,261 (65.9) 581 (4.6) T/3,692 (29.5)T/ 12,534 (100.0) 8,663 1977-78 949 (21.0) 326 (7.2) T/3,253 (71.8)"/ 4,528 (100.0) 1,242 1978-79 1,484 (27.0) 552 (100) T/3,469 (63.0')r/ 5,505 (100.0) 1,865 1979-80 1,778 (32.4) 635 (11.6) l/3,069 (56.06T/ 5,482 (100.0) 2,165 1980-81 2,053 (31.6) 628 (9.7) T/3,809 (58,7)Tr/ 6,490 (100.0) 2,479 1981-82c/ 2,792 (34.5) 750 (9.3) 8/4,553 (56.2)b/ 8,095 (100.0) 3,301 a/ Net of Nlrodh distributed free to Vasectomised cases )from 1970-71 onwards). b/ Includes Equivalent Oral Pill Users also. c/ Provislonal. Note:l. EquIvalent SterilizatIons have been recalculated by revised formula by adding the number of sterilization,1/3 the number of IUD Insertlons, 1/18 number of Equivalent C.C. Users and 1/9 the number of Equivalent Oral Pul Users. 2. Figures In brackets Indicate percentage to total acceptors for each year. Source: Family Welfare Programme In Indla. Yearbook 1981-82. Government of Indla, New Delhi. Table D.1. Annex Table A-2: State-Wise Vasectomies, Tubectomies and Total Sterilization Done During 1980-81, 1981-82 and Since Inception Cumulative since Inception of the progrm 1980-81 1981-82* (upto March, 1982 _ % of % of % of Tubectomny Tubectony Tubectomy Rate per State Vasectomy Tubectomy to total Vasectomy Tubectony to total Vasedtony Tubectomy Total to total 1000 popn. 1 2 3 4 5 6 7 8 9 tO 11 12 13 1. Andhra Pradesh 54,574 189,005 77.6 40,579 249,855 86.0 1,933,124 1,845,445 3,778,569 48.8 69.4 2. Assm 15,134 8,789 36.7 21,414 12,702 37.2 605,588 128,989 734,577 17.6 35.9 3. Bihar 20,449 75,939 78.8 38,577 120,727 75.8 1,697,040 577,918 2,274,958 25.4 31.9 4. GuJarat 37,467 163,127 81.3 47,998 189,407 79.8 1,145,400 1,419,510 2,564,910 55.3 73.8 5. Haryana 5,547 26,980 82.9 6,591 37,854 85.2 451,838 245,358 697,196 35.2 53.0 6. Himachal Pradesh 6,011 8,961 59.9 8,581 14,018 62.0 148,595 92,653 241,248 38.4 55.7 7. Jammu & Kashmlr 4,825 5,705 54.2 2,871 7,590 72.6 92,797 57,327 150,124 38.2 24.5 8. Karnataka 4,785 138,111 96.7 2,498 186,322 98.7 717,598 1,212,248 1,929,846 62.8 50.9 9. Kerala 15,854 97,120 86.0 16,262 107,596 86.9 840,614 816,184 1,656,798 49.3 64.1 -a 10. Madhya Pradesh 40,961 88,988 68.5 33,578 179,792 84.3 2,105,055 824,366 2,929,421 28.1 55.0 11. Maharashtra 81,503 230,374 73.9 199,360 295,244 59.7 3,257,715 2,450,578 5,708,293 42.9 89.1 12. Manipur 1,605 528 24.8 1,814 432 19.2 16,930 4,027 20,957 19.2 14.2 13. Meghalaya 19 244 92.8 11 246 95.7 8,962 5,680 14,642 38.8 10.7 14. Nagaland 31 245 88.8 6 189 96.9 214 1,339 1,533 86.2 1.9 15. Orissa 15,715 77,274 83.1 15,631 94,499 85.8 1,091,384 646,760 1,738,144 37.2 65.0 16. PunJab 7,541 40,091 84.2 14,042 61,308 81.4 276,356 471,334 747,690 63.0 44.0 17. RaJasthan 6,748 93,793 93.3 6,159 135,899 95.7 695,348 450,732 1,146,080 39.3 32.7 18. Sikkim 134 166 55.3 179 231 56.3 848 907 1,755 51.7 5.3 19. Tamll Nadu 8,916 129,915 93.6 14,126 174,702 92.5 2,278,414 1,206,157 3,484,571 34.6 71.0 20. Tripura 344 326 48.7 918 430 31.9 38,322 3,381 41,703 8.1 19.7 21. Uttar Pradesh 11,977 66,461 84.7 14,639 143,980 90.8 1,937,424 653,372 2,590,796 25.2 22.9 22. West Bengal 81,255 128,685 61.3 66,148 151,181 69.6 1,928,520 866,970 2,795,490 31.0 50.3 All India 438,909 1,613,861 78.6 572,595 2,218,984 79.5 21,839,469 14,420,731 36,260,200 39.8 51.9 Source: Family Welfare Programme In India Yearbook, 1981-82. Governnant of India, New Delhi, Table D-9. - 38 - Annex Table A.3: State-Wlse Cu T Insertions Done Durlng 1980-81, 1981-82 and Total IUD Insertions Slnce Inception of the Programne Number of Cu.'T' Insertions Done Cu.'T' (1980-81) Cu.'T' (1981-82)"/ Total IUD Insertions Done Percentage of Percentage of Since Inception Rate per 1000 total total of the progranme population In No. State Number IUD Insertions Number IUD Insertlons up to March, 1982 1981-82 1 2 3 4 5 6 7 8 1. Andhra Pradesh 13,703 78.0 14,660 81.2 340,555 6.3 2. Assam 96 1.6 266 1.7 213,653 10.4 3. Bihar 6,299 29-0 6,827 24.2 454,249 6.4 4. GuJarat 18,387 44.9 33,956 74.4 477,006 13.7 5. Haryana 7,878 31.9 9,937 31.5 624,485 47.4 6. Himachal Pradesh 5,185 74.1 6,561 86.4 90,844 21.0 7. Jammu & Kashmir 2,653 34.7 2,954 63.8 99,103 16.1 8. Karnataka 22,449 41.1 30,446 54.9 573,101 15.1 9. Kerala 6,125 33.3 9,002 43.8 426,712 16.5 10. Madhya Pradesh 7,370 39.6 9,266 39.9 525,288 9.9 11. Maharashtra 21,822 57.6 27,759 68.2 550,592 8.6 12. Manipur 2,023 92.8 1,982 82.4 24,452 16.6 13. Meghalaya 242 85.2 364 94.8 7,807 5.7 14. Nagaland 6 7.0 26b/ 32.5 458 0.6 15. Orissa 13,740 79.6 18,389 87.2 454,749 17.0 16. PunJab 14,640 30.9 22,168 33.0 819,535 48.2 17. Rajasthan 14,350 79.2 14,940 80.7 300,864 8.6 18. Slkkim 507 62.3 105 18.2 3,465 10.5 19. Tamil Nadu 18,938 58.1 20,578 62.4 468,451 9.5 20. Tripura NA - 372 100.0 4,512 2.1 21. Uttar Pradesh 51,077 29.5 67,906 30.2 2,082,667 18.4 22. West Bengal 22,237 71.7 26,298 82.5 493,179 8.9 All India 284,273 45.3 363,995 48.5 9,528,678 13.6 a/ Figures provisional. b/ Figures upto October, 1981 only. N.A. - Not Available. Source: Family Welfare Programme In India. Yearbook, 1981-82. Government of India, New Delhi, Table 0.10. Annex Table A.4: State-Wise Distrlbution of Conventional Contraceptives (Free Distribution) During 1981-82 and 1980-81 No. of pieces distributed 198t-82a/ 1980-81 No. of Condoms No. of Condoms No. of Condoms No. of Condoms Dlstributed Distributed distributed distributed (Gross) (Net)b! JelIy/Cream Foam (Gross) (Net) ' Jelly/Cream Foam State (Fig. in 000's) Diaphragms Tubes Tablets (Fig. In 000's) Diaphragms Tubes Tablets 1 2 3 4 5 6 7 8 9 10 11 12 1. Andhra Pradesh 4,068 3,200 - - - 3,921 3,001 - - - 2. Assam 1,610 1,354 - 474 18 1,312 1,130 20 777 297 3. BIhar, 5,256 4,794 - 21,630 3,760 4,998 4,998 - 7,613 2,257 4. GuJarat 12,455 11,879 - - - 12,601 12,152 - - - 5. Haryana 7,994 7,915 44 170 - 8,267 8,200 56 607 458 6. Himachal Pradesh 1,007 957 - - 50 1,180 1,180 70 - 159 7. Jammiu & Kashmir 607 573 - - - 494 436 - - - 8. Karnataka 6,424 6,409 22 38 - 6,357 6,328 - 35 - 9. Kerala 1,455 1,259 - - - 1,372 1,182 - - - 10. Madhya Pradesh 6,845 6,554 8 1 720 7,034 6,757 12 - 225 to 11. Maharashtra 19,337 17,403 77 1,735 3,294 12,498 11,525 99 1,704 992 12. Manlpur 171 149 - 1,661 - 140 120 - 619 - 13. Meghalaya 18 17 9 66 610 27 27 2 329 1,203 14. Nagaland - - - - - - - - - - 15. Orissa 3,902 3,877 15 293 384 2,519 2,331 9 857 560 16. PunJab 8,995 8,900 39 61 - 7,830 7,793 29 272 - 17. Rajasthan 5,016 4,942 149 208 6 6,667 6,586 35 282 594 18. Sikkim 1 1 - - - 1 1 - - - 19. Tamil Nadu 5,285 4,216 - - - 6,410 5,049 - - - 20. Tripura 147 136 - 131 - 72 68 - 37 39 21. Uttar Pradesh 30,967 30,792 135 6,849 - 22,436 22,359 187 8,182 2,016 22. West Bengal 8,605 7,811 - - - 7,158 6,569 - 51 - Nil India 325,577 318,369 1,065 74,254 13,450 272,627 266,933 1,478 64,223 25,639 a/ Figures are provisional. b/ Net figures of condoms have been obtained after deducting the number of pieces distributed to vasectomised cases tor extra protection. Source: Family Welfare Programme In India. Yearbook. 1981-82 Government of India, New Delhi, Table 0.11 - 40 - Annex Table A-5: State-Wise Number of O.P. Centres Functloning as of March 1982 and Distribution of O.P. Cycles during 1981-82 and 1980-81 No. of centres No. of Oral Pill ? *-0 distributing Oral cycles distributed No. of Equivalent Pills as of 3/82a/ durlng Oral Pill Users No. State Rural Urban 1981-82a/ 1980-817a/ 1981-82a/ 1980-81a/ 1 2 3 4 5 6 7 8 1. Andhra Pradesh 313b, 220b/ 83,752 55,814 6,443 4,293 2. Assaw1 146 37 17,030 4,763 1,310 366 3. Blhar 62b/ 31b/ 42,398 30,100 3,261 2,315 4. GuJarat 251 266t/ 208,394 199,742 16,030 15,365 5. Haryana 88 47 16,565 16,059 1,274 1,235 6. Himachal Pradesh 67 22 2,266 2,147 174 165 7. Jammu & Kashmir 62b/ lob/ 14,032 14,566 1,079 1,121 8. Karnataka 269 159 147,961 116,254 11,382 8,943 9. Kerala 5b/ 18b/ 15,208 9,625 1,170 740 10. Madhya Pradesh 465 101 21,350 20,865 1,642 1,605 11. Maharashtra 427b/ 211b/ 331,831 129,461 25,526 9,959 12. Manipur 27 2 3,160 2,659 243 205 13. Meghalaya 19 5 4,299 1,902 331 146 14. Nagaland NA NA _ 2 - - 15. Orissa 314 47 39,630 31,865 3,048 2,451 16. PunJab 128 29 18,146 6,857 1,396 528 17. RaJasthan 222 134 23,814 29,228 1,832 2,248 18. Sikkim 39b/ lb/ 2,753 7,965 212 613 19. Tamil Nadu 391 380 2,816 52,542 3,294 4,042 20. Tripura 2b/c/ lOb/c/ 10,547 8,833 811 679 21. Uttar Pradesh 900 196 204,382 156,665 15,722 12,050 22. West Bengal 289 97 - 86,986 89,405 6,691 6,877 All India 4,719c/ 2,493c/ 1,553,957 1,186,412 119,535 91 a/ Figures provisional. b/ No. of centres distrlbuting Oral Pills In respect of Andhra Pradesh are as of March, 1981, Bihar as of February, 1981, Jammu & Kashmir as of March, 1980, Kerala as of May 1978, Maharashtra as of October, 1981, Sikkim as of March, 1981, Tripura as of June, 1979. c/ Apart fran these centres, rural/urban break up of 25 centres In respect of Tripura has not been recelved. d/ Includes 17 Private/Pubilc Sector organizations. NA - Not Available. - Nll Source: Family Welfare Programme In India. Yearbook, 1981-82. Government of India, New Delhi, Table 0.12. - 41 - Annex Table A.6: State-Wise Medical Termination of Pregnancies Performed During 1980-81 and 1981-82 ,J.4 No. of Terminations No. of Institutions Since approved for M.T.P. No. State 1980-81 1981-82a/ Inception to 31st March, 1982 1 2 3 4 5 6 1. Andhra Pradesh 14,195 15,126 89,279 98 2. Assam 8,055 9,426 57,471 31 3. Bihar 9,642 9,955 47,183 104 4. GuJarat 21,349 21,990 140,480 457 5. Haryana 5,287 6,596 33,310 130 6. Hlmachal Pradesh 3,086 4,258 16,217 37 7. Jammu & Kashmir NA NA 1,666 NA 8. Karnataka 16,895 16,726 98,696 265 9. Kerala 36,215 35,033 220,677 159 10. Madhya Pradesh 16,482 19,628 104,750 182 11. Maharashtra 41,061 29,455 259,222 635 12. Manipur 1,028 1,406 3,790 3 13. Meghalaya 3 - 2,784 1 14. Nagaland 712 706 3,810 4 15. Orissa 15,961 19,599 76,842 108 16. Punjab 12,434 22,823 75,710 183 17. Rajasthan 11,503 11,706 66,198 223 18. Sikkim - 35 35 NA 19. Tamil Nadu 37,475 42,364 254,393 194 20. Tripura 281 233 3,448 3 21. Uttar Pradesh 85,331 92,606 484,377 351 22. West Bengal 20,293 31,225 165,237 252 All India 388;405 426,551 2,400,556 3,908 a/ Flgures provisional NA - Not Applicable. -- Nil. Source: Family Welfare Programme In India. Yearbook, 1981-82. Government of Indla, New Delhi, Table D.15. Annex Table A.7: State-WIse Number of Couples Currently and EffectIvely Protected hy Varlctjs Methods as on March 1982 SterIlizatIons l.U.D. Other Methods All Methods Est.a/ No. Couples of eligible currently Couples Percent Couples Percent Couples Percent couples and effec- Percent Couples effec- effec- Couples effec- effec- Couples effec- effec- SL March 1982 tively pro- pro- currently tively tively currently tlvely tively Currently tIvely tIVely No. State (In '000) tected tected protected protected protected protected protected protected protected protected protected 1 2 3 4 5 6 7 8 9 10 11 12 13 14 I. Andhra Pradesh 9,807 2,604,429 26.6 35,763 33,975 0.3 50,893 28,668 0.3 2,691,085 2,667,072 27.2 2. Assam 3,010 519,524 17.3 21,962 20,864 0.7 20,176 10,743 0.3 561,662 551,131 18.3b 3. Blhar 13,332 1,540,907 11.6 49,273 46,809 0.3 72,980 38,121 0.3 1,163,160 1,625,837 12.2 4. GuJarat 5,700 1,811,930 31.8 84,934 80,687 1.4 181,018 98,524 1.7 2,077,882 1,591,141 34.9 5. Haryana 2,119 487,333 23.0 66,488 63,164 3.0 111,255 56,265 2.6 665,076 606,762 28.6 6. Mlmachal Pradesh 749 174,837 23.3 14,058 13,355 1.8 13,462 6,818 0.9 202,357 195,010 26.0 7. Jemmu l Kashmir 1,037 96,284 9.3 11,116 10,560 1.0 9,034 5,056 0.5 116,434 111,900 10.8 S. Karnataka 6,214 1,382,673 22.2 102,852 97,709 1.6 100,407 55,895 0.9 1,585,932 1,536,277 24.7 9. Kerala 3,618 1,110,118 30.7 39,261 37,298 1.0 18,662 9,916 0.3 1,168,041 1,157,332 32.0 1 10. Madhya Pradesh 9,483 1,972,229 20.8 46,366 44,048 0.5 92,685 47,164 0.5 2,111,280 2,063,441 21.8 T 11. Maharashtra 10,950 3,805,785 34.8 70,613 67,082 0.6 267,572 146,549 1.3 4,143,970 4,019,416 36.7 l" 12. Manlpur 190 16,752 8.8 4,330 4,114 2.2 2,550 1,396 0.7 23,632 22,262 11.7b/ 1 13. Meghalaye 201 10,322 5.1 786 747 0.4 592 461 0.2 11,700 11,530 5.7z6/ 14. Nagaland 99 1,148 1.2 133 126 0.1 - - - 1,281 1,274 1.3F/ 15. Orlssa 4,680 1,155,113 24.7 40,024 38,023 0.8 56,946 29,997 0.6 1,252,083 1,223,133 26.1 16. Punjab 2,432 501,839 20.6 107,497 102,122 4.2 125,039 63,218 2.6 734,375 667,179 27.4 17. Rajasthan 6,267 831,337 13.3 39,590 37,611 0.6 70,577 36,205 0.6 941,504 905,153 14.5b/ 18. Slkklm 42 1,602 3.8 1,317 1,251 3.0 227 219 0.5 3,146 3,072 7.3lr/ 19. Tamil Nadu 8,294 2,197,460 26.5 68,792 65,352 0.8 61,848 32,571 0.4 2,328,100 2,295,383 27.7 20. Tripura 329 26,449 8.0 726 690 0.2 2,714 1,762 0.5 29,889 28,901 8.8b/ 21. Utter Prodesh 20,057 1,639,474 8.2 415,602 394,822 2.0 444,430 230,076 1.1 2,499,506 2,264,372 11.3r/ 22. West Bengal 8,450 1,946,591 23.0 55,310 52,544 0.6 115,180 60,936 0.7 2,117,081 2,000,001 24.4 All India 118,767 24,532,737 20.7 1,377,800 1,308,909 1.1 4,552,648C/ 2,336,091c/ 2.0 30,463,185c/ 28,177,737C/ 23.7 a/ Estimates of couples wIth wIves In the age-group 15-44 years have been worked out on the basis of proportlon of currently rmrrled femeles to the total population as of 1971 census. Estimate of population as of 31st March 1982 were extrapolated. b/ Below all Indla measures. c/ Includes 12,184 oral pill users reported by Family Welfare Assoclatlon of India and C.M.A.I. Projects Source: Family Welfare Progranme In India. Yearbook, 1981-82. Government of Indl, New Delhi, Table E.2 - 43 - Annex Table A.8. Total Marital Fertility Rate 1972, 1978 Urban Rural States* 1972 1978 1972 1978 1. Andhra Pradesh 4.92 3.7 5.60 4.8 2. Assam 5.37 5.2 7.42 6.0 3. Bihar 4.91 4.1 5.73 4.8 4. Gujarat 6.1 5.0 7.8 5.7 5. Haryana 6.45 4.54 8.15 5.38 6. Jammu and Kashmir 8.38 4.8 9.61 5.7 7. Karnataka 4.8 4.5 5.80 5.0 8. Kerala 6.81 4.7 6.87 4.8 9. Madhya Pradesh 6.47 5.1 7.81 5.9 10. Maharashtra 5.43 4.4 5.89 4.3 11. Orissa 5.47 5.1 5.90 5.6 12. Punjab 6.66 5.2 7.33 5.7 13. Rajasthan 6.22 4.6 7.75 6.0 14. Tamil Nadu 5.06 4.3 5.88 4.8 15. Uttar Pradesh 6.4 5.6 8.0 6.6 16. West Bengal 5.57 4.3 - 4.8 * States with a population of 5 million or more in 1981. Source: 1972: Vital Statistics Division, Otfice of Registrar General Census Commissioner. Fertility Differentials in India, 1972. Ministry of Home Aftairs, New Delhi, Appendix I Table 15. 1978: Vital Statistics Division, Office of Registrar General. Levels, Trends and Ditterentials in Fertility 1979. Ministry of Home Affairs, New Delhi, p. 5. - 44 - Annex Table A.9. Total Fertility Rate by Educational Attainment, Rural, by States, 1978 Literate but Primary Metric All States* Illiterate below primary below metric & above literate 1. Andhra Pradesh 4.15 3.50 3.20 2.54 3.38 2. Assam 4.34 4.49 2.88 2.50 3.69 3. Bihar 4.21 4.30 3.88 4.65 4.23 4. Gujarat 4.95 3.40 3.19 1.67 3.23 5. Haryana 4.73 3.77 3.68 3.12 3.57 6. Jammu and Kashmir 4.92 4.01 2.96 2.68 3.01 7. Karnataka 3.91 3.25 3.06 1.48 3.07 8. Kerala 3.52 3.06 2.51 1.70 2.68 9. Madya Pradesh 5.22 5.27 4.59 3.52 4.96 10. Maharashtra 3.97 3.12 3.00 2.32 3.16 11. Orissa 4.24 4.92 4.70 2.33 4.28 12. Punjab 4.57 3.37 3.69 2.49 3.43 13. Rajasthan 5.63 4.30 4.22 2.55 4.12 14. Tamil Nadu 3.71 3.20 3.02 2.04 3.05 15. Uttar Pradesh 6.04 5.62 5.UU 4.37 5.22 16. West Bengal 3.94 3.11 2.04 1.84 2.66 17. India 4.74 3.85 3.61 2.48 3.56 * States with a population of 5 million or more in 1981. Source: Vital Statistics Division, Office of the Registrar General. Levels, Trends and Differentials in Fertility, 1979. Ministry of Home Affairs, New Delhi. Compiled using State Tables. - 45 - Annex Table A.10. Total Fertility Rate by Educational Attainment, Urban, by States, 1978 Literate but Primary Metric All States* Illiterate below primary below metric & above literate 1. Andhra Pradesh 2.96 2.69 2.74 1.80 2.51 2. Assam 3.82 3.91 2.83 1.30 2.82 3. Bihar 3.84 3.15 2.83 1.51 2.84 4. Gujarat 4.51 3.42 2.80 2.21 2.88 5. Haryana 2.92 2.99 2.98 2.52 2.78 6. Jammu and Kashmir 3.30 3.32 2.55 1.93 2.37 7. Karnataka 3.52 3.44 2.36 2.01 8. Kerala 3.41 2.71 2.43 1.64 9. Madya Pradesh 4.55 4.06 3.45 2.96 3.44 10. Maharashtra 3.84 3.35 2.42 1.83 2.46 11. Orissa 3.73 4.25 3.22 1.51 3.37 12. Punjab 4.32 3.51 3.41 2.36 2.72 13. Rajasthan 4.45 3.59 2.99 2.05 2.94 14. Tamil Nadu 3.37 2.91 2.68 1.66 2.50 15. Uttar Pradesh 5.25 4.08 3.42 1.95 3.14 16. West Bengal 4.14 3.05 1.68 1.23 2.66 17. India 4.00 3.27 2.61 1.88 2.58 * States with a population of 5 million or more in 1981. Source: Vital Statistics Division, Office of the Registrar General. Levels, Trends and Differentials in Fertility, 1979. Ministry of Home Affairs, New Delhi. Compiled using State Tables. - 46 - Annex Table A.11. Total Marital Fertility Rate by Educational Attainment Rural by States, 1978 Literate but Primary Metric All States* Illiterate below primary below metric & above literate 1. Andhra Pradesh 4.88 4.53 4.47 4.19 4.58 2. Assam 5.80 6.60 5.94 5.62 6.36 3. Bihar 4.76 4.85 4.57 7.23 4.i7 4. Gujarat 5.94 4.38 4.48 2.85 4.38 5. Haryana 5.39 4.97 5.18 4.80 5.02 6. Jammu and Kashmir 5.67 4.74 5.1U 4.70 5.02 7. Karnataka 5.09 4.69 5.27 3.49 4.78 8. Kerala 5.13 4.79 4.50 4.46 4.87 9. Madya Pradesh 5.89 6.00 5.69 5.64 5.- 10. Maharashtra 4.38 3.76 3.97 4.57 4.87 11. Orissa 5.49 6.16 6.64 4.90 6.25 12. Punjab 5.76 4.85 5.58 4.44 5.25 13. Rajasthan 6.01 4.80 5.06 3.49 4.76 14. Tamil Nadu 4.82 4.66 4.96 4.74 4.38 15. Uttar Pradesh 6.65 6.68 5.78 6.02 6.40 16. West Bengal 5.05 4.29 3.72 3.87 4.13 * States with a population of 5 million or more in 1981. Source: Vital Statistics Division, Office of the Registrar General. Levels, Trends and Differentials in Fertility, 1979. Ministry of Home Affairs, New Delhi. Compiled using State Tables. - 47 - Annex Table A.12. Total Marital Fertility Rate by Educational Attainment, Urban by States, 1978 Literate but Primary Metric All States* Illiterate below primary below metric & above literate 1. Andhra Pradesh 3.62 3.56 3.99 3.66 3.78 2. Assam 5.26 5.61 5.49 3.85 5.22 3. Bihar 4.34 3.66 3.68 3.77 3.64 4. Gujarat 5.75 4.37 3.91 3.74 4.07 5. Haryana 4.73 4.01 4.24 4.47 4.34 6. Jammu and Kashmir 4.61 5.IU 4.70 5.02 4.85 7. Karnataka 4.53 5.04 3.25 4.30 4.53 8. Kerala 5.26 4.61 4.63 3.80 4.56 9. Madya Pradesh 5.30 4.96 4.67 6.08 4.90 10. Maharashtra 4.83 4.45 4.U8 3.92 4.13 11. Orissa 4.95 5.69 5.17 3.19 5.25 12. Punjab 5.58 5.60 5.21 4.15 4.89 13. Rajasthan 4.91 4.23 3.85 3.58 3.96 14. Tamil Nadu 4.53 4.18 4.2b 3.78 4.12 15. Uttar Pradesh 6.25 5.13 4.92 4.2b 4.81 16. West Bengal 5.39 4.35 3.75 2.57 3.78 * States with a population of 5 million or more in 1981. Source: Vital Statistics Division, Office of the Registrar General. Levels, Trends and Differentials in Fertility, 1979. Ministry of Home Affairs, New Delhi. Compiled using State Tables. - 48 - Annex Table A.13. Total Marital Fertility, Rural, by Age at Marriage, 1978 States* Below 18 18-20 21+ 1. Andhra Pradesh 4.9 4.3 3.8 2. Assam 5.87 5.46 5.49 3. Bihar 4.66 4.38 3.95 4. Gujarat 5.7 5.5 4.8 5. Haryana 5.43 5.10 5.21 6. Jammu and Kashmir 5.66 5.31 4.69 7. Karnataka 5.11 4.40 4.40 8. Kerala 4.86 4.03 4.03 9. Madhya Pradesh 6.02 5.00 4.66 10. Maharashtra 4.21 4.10 4.23 11. Orissa 5.60 5.31 5.34 12. Punjab 5.53 5.15 5.77 13. Rajasthan 6.1 5.5 5.7 14. Tamil Nadu 4.81 4.36 4.38 15. Uttar Pradesh 6.7 6.2 5.7 16. West Bengal 4.9 4.2 3.7 17. India 5.41 5.03 4.67 * States with a population of 5 million or more in 1981. Source: Vital Statistics Division, Office of the Registrar General. Levels, Trends and Differentials in Fertility, 1979, Ministry of Home Affairs, New Delhi. Compiled using State Tables. - 49 - Annex Table A.14. Total Marital Fertility, Urban, by Age at Marriage, 1978 States* Below 18 18-20 21+ 1. Andhra Pradesh 3.6 3.5 3.7 2. Assam 5.00 4.77 4.00 3. Bihar 4.31 3.58 2.54 4. Gujarat 5.1 4.4 4.4 5. Haryana 4.25 4.31 4.57 6. Jammu and Kashmir 4.48 4.43 3.55 7. Karnataka 4.59 3.93 3.89 8. Kerala 4.52 4.01 3.62 9. Madhya Pradesh 5.16 5.02 3.96 10. Maharashtra 4.50 3.62 3.30 11. Orissa 5.19 4.55 4.50 12. Punjab 5.05 5.04 4.05 13. Rajasthan 4.7 4.3 4.2 14. Tamil Nadu 4.30 4.02 3.14 15. Uttar Pradesh 5.9 4.6 4.1 16. West Bengal 4.4 3.4 3.1 17. India 4.bl 4.06 3.53 * States with a population of 5 million or more in 1981. Source: Vital Statistics Division, Office of the Registrar General. Levels, Trends and Differentials in Fertility, 1979, Ministry of Home Affairs, New Deini. Compiled using State Tables. - 50 - Annex Table A.15. Total Marital Fertility, Rural, by Per Capital Monthly Expenditure, 1978 States* Below Rs 50 51-100 101+ 1. Andhra Pradesh 6.1 4.3 3.2 2. Assam 6.84 5.42 4.43 3. Bihar 5.0 4.0 4.1 4. Gujarat 6.29 5.17 2.62 5. Haryana 6.88 5.20 4.32 6. Jammu and Kastmir 6.73 5.59 3.65 7. Karnataka 5.84 4.56 2.65 8. Kerala 5.89 4.16 3.1U 9. Madhya Pradesh 6.78 4.92 4.23 10. Maharashtra 4.61 3.86 3.04 11. Orissa 6.18 4.92 4.23 12. Punjab 6.61 5.67 3.33 13. Rajasthan 7.0 5.6 2.2 14. Tamil Nadu 5.52 3.78 1.99 15. Uttar Pradesh 6.22 5.09 3.84 16. West Bengal 5.5 4.4 4.4 17. India 6.05 4.78 3.49 * States with a population of 5 million or more in 1981. Source: Vital Statistics Division, Office of the Kegistrar General. Levels, Trends and Differentials in Fertility, 1979, Ministry of Home Affairs, New Delhi. Compiled using State Tables. - 51 - Annex Table A.16. Total Marital Fertility, Urban, by Per Capita Monthly Expenditure, 1978 States* Below Rs 50 51-100 1U1+ 1. Andhra Pradesh 5.2 4.0 1.9 2. Assam 7.21 5.63 3.38 3. Bihar 4.71 3.88 2.4 4. Gujarat 6.36 5.15 3.24 5. Haryana 6.42 4.67 3.59 6. Jammu and Kashmir 6.14 5.22 2.52 7. Karnataka 5.66 4.76 2.64 8. Kerala 5.75 4.38 3.07 9. Madhya Pradesh 6.52 4.92 3.14 10. Maharashtra 6.25 4.40 2.94 11. Orissa 6.27 5.09 3.30 12. Punjab 7.75 5.22 4.15 13. Rajasthan 5.8 4.7 2.8 14. Tamil Nadu 5.89 4.05 2.72 15. Uttar Pradesh 6.83 5.32 3.96 16. West Bengal 4.5 4.0 2.5 17. India 5.72 4.62 2.97 * States with a population of 5 million or more in 1981. Source: Vital Statistics Division, Office of the Registrar General. Levels, Trends and Uifferentials in Fertility, 1979, Ministry of Home Affairs, New Delhi. Compiled using State Tables. - 52 - Annex Table A.17. Total Fertility Rate, Rural, by Religion, 1978 Schedule Schedule States* Hindu Muslim Christian Sikh Caste Tribe 1. Andhra Pradesh 3.99 4.99 4.27 - 3.94 2.57 2. Assam 3.86 4.70 - - 4.73 4.38 3. Bihar 4.23 4.30 - - 4.34 3.21 4. Gujarat 4.61 4.58 - - 4.61 4.5o 5. Haryana 4.61 4.65 - 4.05 5.36 - 6. Jammu and Kashmir 4.93 4.77 - - 5.68 - 7. Karnataka 3.70 3.83 - - 3.59 - 8. Kerala 2.49 4.15 2.43 - 2.74 - 9. Madhya Pradesh 5.Jb 5.45 - - 5.95 4.51 10. Maharashtra 3.62 4.74 - - 3.38 3.68 11. Orissa 4.30 6.34 - - 3.93 3.63 12. Punjab 4.39 - - 3.15 4.78 - 13. Rajasthan 5.50 5.92 - - 5.58 3.35 14. Tamil Nadu 3.43 3.64 3.82 - 3.70 - 15. Uttar Pradesh 5.82 6.39 - - 5.98 - 16. West Bengal 3.32 4.55 - - 3.98 2.96 17. India 4.48 5.01 3.34 3.97 4.78 4.07 * States with a population of 5 million or more in 1981. Source: Vital Statistics Division, Office of the Kegistrar General. Levels, Trends and Differentials in Fertility, 1979. Ministry of Home Affairs, New Delhi. Compilea using State Tables. - 53 - Annex Table A.18. Total Fertility Rate, Urban, by Religion, 1978 Schedule Schedule States* Hindu Muslim Christian Sikh Caste Tribe 1. Andhra Pradesh 2.66 3.14 1.96 - 3.24 3.79 2. Assam 2.73 3.23 - - 3.46 - 3. Bihar 3.33 4.05 - - 2.96 1.66 4. Gujarat 3.64 3.84 - - 4.37 4.77 5. Haryana 3.20 3.24 - 3.33 4.15 - 6. Jammu and Kashmir 2.62 2.92 - - 4.07 - 7. Karnataka 2.94 3.69 - - 3.54 - 8. Kerala 1.92 3.63 1.83 - 2.18 - 9. Madhya Pradesh 3.77 4.09 - - 3.90 4.91 10. Maharashtra 2.64 3.81 - - 4.18 3.53 11. Orissa 3.47 4.12 - - 3.77 3.15 12. Punjab 3.18 - - 3.12 4.23 - 13. Rajasthan 3.77 6.11 - - 4.39 7.07 14. Tamil Nadu 2.67 3.24 3.24 - 2.94 - 15. Uttar Pradesh 3.21 3.88 - - 4.79 - 16. West Bengal 2.29 4.3u - - 4.49 2.30 17. India 2.97 3.98 2.31 3.03 3.88 3.62 * States with a population of 5 million or more in 1981. Source: Vital Statistics Division, Office of the Registrar General. Levels, Trends and Differentials in Fertility, 1979. Ministry of Home Affairs, New Delhi. Compiled usi g State Tables. - 54 - Annex Table A.19. Total Marital Fertility, Rural, by Religion, 1978 Schedule Schedule States* Hindu Muslim Christian Sikh Caste Tribe 1. Andhra Pradesh 4.78 5.93 5.68 - 4.86 5.38 2. Assam 5.99 6.08 - - 6.35 7.03 3. Bihar 4.78 4.91 - - 4.72 4.48 4. Gujarat 5.71 5.50 - - 6.52 6.11 5. Haryana 4.05 5.22 - 7.51 6.14 - 6. Jammu and Kashmir 5.86 5.55 - - 6.53 - 7. Karnataka 5.05 5.16 - - 4.65 - 8. Kerala 4.60 5.63 4.85 - 4.61 - 9. Madhya P a esh 5.92 6.24 - - 6.44 5.17 10. Maharashtra 4.22 5.51 - - 3.90 4.67 11. Orissa 5.58 8.58 - - 4.91 5.15 12. Punjab 5.72 - - 5.73 6.04 - 13. Rajasthan 5.98 6.80 - - 6.01 5.99 14. Tamil Na u 4.75 4.99 5.72 - 4.85 - 15. Uttar Pradesh 6.55 7.35 - - 6.60 - 16. West Bengal 4.62 5.73 - - 5.12 4.10 17. India 5.37 5.98 5.07 35.66 5.56 5.25 * States with a population of 5 million or more in 1981. Source: Vital Statistics Division, Office of the Registrar General. Levels, Trends and Differentials in Fertility, 1979. Ministry of Home Affairs, New Delni. Compiled using State Tables. - 55 - Annex Table A.20. Total Marital Fertility, Urban, by Religion, 1978 Schedule Schedule States* Hindu Muslim Christian Sikh Caste Tribe 1. Andhra Pradesh 3.64 4.13 3.24 - 4.06 4.20 2. Assam 5.28 5.23 - - 6.06 - 3. Bihar 3.95 4.91 - - 3.25 2.52 4. Gujarat 4.82 5.80 - - 5.32 6.22 5. Haryana 4.53 4.28 - 4.72 5.04 - 6. Jammu and Kashmir 4.65 4.77 - - 5.18 7. Karnataka 4.30 5.90 - - 5.45 8. Kerala 4.50 5.23 3.77 - 4.53 9. Madhya Pradesh 5.Q6 5.43 - - 4.79 6.U8 10. Maharashtra 4.11 5.30 - - 5.61 4.64 11. Orissa 5.04 6.00 - - 4.27 12. Punjab 4.90 - - 5.95 5.62 - 13. Rajasthan 4.55 5.34 - - 5.03 8.23 14. Tamil Nadu 4.15 4.75 5.69 - 4.26 - 15. Uttar Pradesh 5.17 6.77 - - 5.53 - 16. West Bengal 4.06 5.95 - - 5.75 5.88 17. India 4.37 5.53 4.54 5.076 5.03 4.97 * States with a population of 5 million or more in 1981. Source: Vital Statistics Division, Office of the Registrar General. Levels, Trends and Differentials in Fertility, 1979. Ministry of Home Affairs, New Delhi. Compiled using State Tables. W orid Bank value of these findings and provides Demographic Aspects of valuable insights into possibilities for Migration in West Africa- Publications implementing mass programs for K C. Zachanah and others needy people in villages throughout of Related the world Volume 1 Staff Working Paper No 414. September IntereVst 1980 369 pages (including statistical an- Volume 1: Integrated Nutrition nexes, bibliography) and Health Care Stock No WP 0414 $15 Arnfried A. Kielmann and others This volume provides detailed data Volume 2 suggesting that synergism between Staff Working Paper No 415 September malnutrition and infection is probably 1980 391 pages (includtng statistical an- the greatest cause of mortality, mor- nexes, bibliography). The African Trypanosomiases: bidity, and retarded growth and devel- Stock No WP 0415 $15 Methods and Concepts of over a penod of four years, villagers (These Working Papers are background Control and Eradication in received nutntion care, general health studies for Migration in West Afnca. Relation to Development care to control infections, or both Dra- Demographic Aspects, described in this C. W Lee and J. M. Maurice matic improvements, including a 40%- section ) Here is a practical cost-benefit ap- 50% decline in mortality, a 20% reduc- Economic Motivation versus proach to an age-old problem affecting creases in height and weight In addi- City Lights: Testing humans and livestock alike, the Afn- hon, detailed information on costs is Hypotheses about Inter- can Trypanosomiases Descnbes new presented that permits the most com- Changwat Migration in techniques that offer tsetse control plete analysis of cost-effectiveness and Thailand without destroying game animals. program relevant costs and benefits Fred Arnold and Susan H. Also summarizes current research in ye grial n hskn o il e genetic control, the use of sraps and search. The study focuses directly oncrane screens, attractants, and pheromones. practcal program implications and Staff Working Paper No 416 September Technical Paper No 4 1983 107 pages ways in which such integrated services 1980 41 pages (including footnotes, refer- ISBN 0-8213-0191-8 Stock No BK 0191 can be applied under field conditions. ences) $5 The Johns Hopkins University Press 1984 Stock No WP 0416 $3 Analyzing the Impact of 288 pages. Experiments in Family Health Services: Project LC 82-23915. ISBN 0-8018-3064-8 Stock Planning: Lessons from the Experiences from India, Developing World Ghana, and Thailand Roberto Cuca and Catherine S Rashid Faruqee Pierce Staff Working Paper No 546 1982 44 Volume 1. Integrated Family A comprehensive review of experi- pages Planning and Health Care mental efforts in the developing world ISBN 0-8213-0117-9 Stock No WP 0546 Carl E. Taylor and others to determine more effective ways of $3 To village people, politicians, and in- providing family planning services ternational health planners, health and The Johns Hopktns University Press, 1978 family planning have always seemed 276 pages (including bibliography, index of NEW to fit naturally together But in the experiments) early 1960s, when international aware- LC 77-16596 ISBN 0-8018-2013-8, Stock Child and Maternal Health ness of the social and economic conse- No IH 2013, $19 50 hardcover, ISBN 0- quences of surging population growth 81-046 tc oI 04 89 Services in India: The moved family planning into a position pS2erback Narangwal Experiment of high priority, some international par What can pnmary health care and agencies began to advocate separation Family Planning Programs: An family planning do for women and of family planning from health serv- Evaluation of Experience children in the poor and depnved ices In international policy discussions Roberto Cuca areas of the world7 Some of the most the question continues to be impor- specific evidence available today to tant This volume analyzes this ques- Staff Working Paper No 345 19,9 146 support the benefits of these services ton and provides arguments and evi- pages (including 2 annexes, reterenices) is contained in these two studies, dence to support integration of health Stock NVo WP 0345 55 which represent the findings of re- care and family planning; it outlines search carned out during 1967-74 in the purposes underlying the research Fertility and Education: What twenty-six villages in Punjab, India in this area, and it proposes policy Do We Really Know? questions regarding the effectiveness, Susan H Cochrane Members of the research staff, which efficiency, and equity of such an inte- Amdlietfigtemn hn started with 15 people and grew to grtion A model identifvig the manv chan- about 150 by the end of the project, gra nels through which education might spent many years working with, and The Johns Hopkins University Press. 1984. shanng the lives of, villagers The 256 pages depth of understanding that came LC 83-23915 ISBN 0-8018-2830-9 Stock Prices subject to change without notice from this type of sharing enhances the No IH 2830 S22 50. and may vary by country. act to determine fertility and a review Health Issues and Policies in Kenya: Population and of the evidence of the relation between the Developing Countries Development education and the intervening vana- Fredrick Golladay (See descnption under Country bles In the model that affect fertilitv bles Hopkinsthe modelthat affet , fertiy Staff Working Paper No 412 1980 55 Studies listing.) The Johns Hopkins University Press, 1979 pages 188 pages (including bibliography, index) pag LC 78-26070 ISBN 0-8018-2140-1, Stock Stock No WP 0412 $3 No IH 2140. S6 95 paperback Health, Nutrition, and Family Migration in West Africa: Planning in India: A Survey of Demographic Aspects Experiments and Special K C. Zachariah and Julien Conde Fertility and Its Regulation in Projects The first study of the large-scale move- Fertility ~~~~~~~~~~~~~~~~~ment cf people in nine West African Bangladesh Rashid Faruqee and Ethna Johnson countnes. Discusses the volume and R Amin and Rashid Faruqee Staff Working Paper No 507 1982 Z08 direchon of internal and external flows Staff Working Paper No 383 1980 54 pages (including references) and the economic and social character- pages (including references) Stock No WP 0507 S5 istics of migrants. Stock No WP 0383 53 A joint World Bank-OECD study. Oxford Infant and Child Mortality as a University Press, 1981 166 pages (includ- Determinant of Fertility: The ing 22 maps, bibliography, index) Health Policy Implications LC 80-21352 ISBN 0-19-520186-8, Stock Fredrick Golladay, coordinating Susan Hill Cochrane and K. C. No OX 520186, $19 95 hardcover; ISBN author Zachariah 0-19-520187-6, Stock No OX 520187, Draws on expenence gained from An illustrative analysis that suggests $8 95 paperback health components of seventv World intant mortality mav be an important Bank projects in fortv-four countnes component of a fertility reduction pro- between 1975 and 1978 Emphasizes gram in countries where mortality is P a the disproportionately high expendi- high and few couples are able to have Populanion and Famdly tures incurred on curative medicine, the number of surviving children they Planning in Bangladesh: A maintenance of expensive hospitals, desire Study of the Research and sophisticated training of medical World Bank Staff Working Paper No 556 Mohammad Alauddin and Rashid personnel at the cost of preventive 1983 44 pages Faruqee care for the majonty of the people Points out that low-cost health care ISBN 0-8213-0147-0 Stock No WP 0556 Reviews major studies on family plan- svstems are feasible and recommends 53 ning and on fertility trends, profiles, tsat the Bank begin regular and directnds.$. and determinants Evaluates results of lending for health, in addition to hav- Integrating Family Planning such studies and cntiquies their meth- ing halthcompoentsas pat ofpro- with Health Services: Does It odology and application Underscores ing health components as part of pro need for continued studv and suggests jects In other sectorsHelp. directions for future research to im- Sector Policy Paper 1980 90 pages (in- Rashid Faruqee prove the Bangladesh population cluding 8 annexes, 4 figures, map) Staff Working Paper No 515 1982 47 problem Stock Nos BK 9066 (Arabic), BK 9067 pages World Bank Staff Working Paper No 557 (English), BK 9068 (FrencIh). 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