257 Million Women Worldwide Have Unmet Need for Safe, Reliable Contraception: Report

According to the UNFPA report,  44% of partnered women and girls in 68 reporting countries do not have the right to make informed decisions about their bodies on matters of sex, contraception and seeking health care which indicates that nearly half of all pregnancies are unintended.

New Delhi: Around 257 million women worldwide have an unmet need for safe and reliable contraception, according to the State of World Population (SOWP) report 2023 released by United Nations Population Fund (UNFPA). Moreover,  44% of partnered women and girls in 68 reporting countries do not have the right to make informed decisions about their bodies on matters of sex, contraception and seeking health care.

The report titled “8 Billion Lives, Infinite Possibilities: the case for rights and choices,” released on April 3, mentioned that unmet need for contraception has barely fallen in decades, moving from 12.2% in 2000 to 10.6% in 2023 among partnered women. Moreover, looking forward, projections to the year 2030 indicate an increase in the number of women with a need for family planning to 1.2 billion and, because of population growth, 262 million women would still have an unmet need for modern contraception, up from the absolute number of 257 million in 2023.

As per the report, the most recent data from 68 countries show that an estimated 44% of partnered women are unable to make decisions over health care, sex or contraception which indicates that nearly half of all pregnancies are unintended,  an abrogation of women’s basic human right to decide freely and responsibly the number and spacing of their children.

 “So many women lack control over their bodies, including the right to have children – to decide when they want to have them and how many,” said Poonam Muttreja, Population Foundation of India’s (PFI’s) Executive Director,  in a statement.

According to the fifth round of the National Family Health Survey (2019-21), India’s unmet need for contraception is 9.4%, which underlines that even when couples want to adopt a contraceptive method, it is not available to them, the PFI mentioned . Moreover, one out of every four women in India are married before they turn 18.

The SOWP also underlined that India’s population is fractionally higher than China’s in 2023 — India at 1428.6 million versus 1425.7 million for China. Further, the report stated that with the world having hit the 8 billion mark in November 2022, an alarming discourse around population issues gained momentum.

However, the PFI expressed concerns citing that these issues tend to be viewed in isolation, with women and their right to bodily autonomy taking a backseat and rising or a declining population is often viewed with anxiety. The governments across the world respond with policies aimed at increasing or decreasing fertility, and in the process, hold women’s bodies to population targets, the organisation mentioned. 

Muttreja said, “India had done many things right. The government has made contraceptive options available to people, while programmes such as Mission Parivar Vikas are reaching out to districts which are underserved. However, even as India becomes the most populous country in the world, the programmatic discourse should focus on ensuring that comprehensive and equitable services are available to people regardless of where they live or which strata of society they belong to. At the same time, we need to make sure that girls and women are not pushed into early marriages and pregnancies, which limit their aspirations. We urgently need to ensure the education and skilling of our young population.”

“In spite of progress on many fronts, patriarchy is deep-rooted in the country, and this gets reflected in the performance of the reproductive health programme too. Almost the entire responsibility for family planning is on women. We need to move towards greater involvement of men in family planning. It is also important to for more girls and women to get better educated, join the workforce, delay marriage, and postpone pregnancies,” Muttreja added.

A Knotty Affair: India’s Burgeoning Population and Stagnating Middle-Income

The middle class in India is feeling the squeeze because real wages have not risen, but costs are rising.

As per the State of World Population Report published by the United Nations Population Fund, India will soon become the most populous country in the world. At this point, India also has a relatively ‘younger’ working-age population compared to China. Depending upon how one reads the data, this can be a boon or bane, as labour is an important component of growth in national income or gross domestic product (GDP).

If labourers are productive, then their income and the economy grow. Much of the GDP growth that occurred among the emerging Asian economies during the second half of the last century was through increased labour force participation. These countries, for example, China, South Korea, Singapore, Taiwan, and Vietnam, were able to absorb labour from the low-productive agricultural sector to the high-productive manufacturing sectors. Much of the supply of white goods like mobile phones, air conditioners, refrigerators, computers, etc. are manufactured in these countries, thereby making their economy transition from low to middle and high-income economies.

This is why there is a flourishing middle class in these economies. According to Pew Research, the share of Chinese who are in the middle-income group jumped from 3% to 18% during this century, however, the share of Indians middle-income group remain unchanged for the most part. Although, thanks to reforms and the consequential high growth rates in GDP, India was able to reduce poverty – from 40% in 2004 to 10% in 2019 – however, the drop in poverty merely resulted in an increase in the low-income population. Data from the recently published India Consumer Economy 360 survey points towards a fall in income growth for the poor and middle-income households, whereas that of the high-income households surged.

Source: India’s Consumer Economy (ICE) 360 survey

Ergo, although in India the poor are becoming richer, the society is also becoming more unequal, that is, the rich are becoming richer much faster. New World Wealth, a Johannesburg-based company, published a report claiming that India is the second-most unequal country in the world, with millionaires controlling 54% of the wealth. In Japan, the most equal country in the world, millionaires control only 22% of the national wealth. In India, the number of ultra-high-net-worth individuals (with net assets of $30 million or more) has grown by 11% year-on-year in 2021, the highest percentage growth in the Asia-Pacific. 

A reason for unequal income distribution is that most of our labourers are stuck in low-productive sectors. According to the Periodic Labour Force Survey (PLFS) 2021-22, agriculture still remains the largest source of employment, employing 45.5% of the workforce. Construction is at a distant second, employing 12.4%, closely followed by trade, hotel and restaurant, employing 12.1% of the workforce. Now all these sectors require low/semi-skilled labourers, with low productivity. 

India’s labour productivity – economic output per hour of work – is just 12% of the US levels. In purchasing parity terms, GDP per hour worked is $70.68 for the US, in comparison to India’s $8.47, and this cannot be explained by differences in the working population alone. Types of employment, and access to finance and technology matter. For a long time, output per hectare, a common measure of agriculture productivity, remained low in India. For example, in potato farming, the productivity of an Indian farmer is less than half of that of the US, Germany, and the Netherlands. In the case of rice, it is less than half of that of the US and Egypt, and for wheat, it is less than half of that of the UK and Egypt.

India leapfrogged into services without being able to create enough jobs in the manufacturing sector. Even the success stories of the manufacturing sector – Reliance, Godrej, Tata Group, etc – employ a capital-intensive mode of production. For a long, everyone thought labour market reforms such as giving more power to the companies to hire and fire workers will bring in the required change. That did not happen in spite of the Central labour law reforms in 2020.

Instead, over the last five years, there has been an increase in self-employment in low-productive agriculture and the urban informal sector. There are not enough jobs getting created and according to PLFS 2021-22, on the basis of current weekly status unemployment level remained stagnant at 8.8%, without declining much since 2017. High skilled-services sectors such as banks, Information Technology, etc., are not able to absorb workers. In India, according to PLFS 2021-22, only 1.3 % have technical education and only 0.7% have diploma/certificate graduate level in vocational education. Technical knowledge and education are a must for getting a job in the manufacturing or service sectors. On the other hand, a concomitant rise in income inequality is leading to the creation of low-paid and low-productive jobs such as housekeeping, security services, and other gig-type jobs such as Zomato delivery workers

A photo of Swiggy and Zomato delivery workers. Photo: PTI

Rising costs, wages stagnant

A low productive workforce means a lower income, in particular when the informal labour markets are monopsonistic (a higher number of labourers looking for jobs as opposed to employers or aggregators). There has been no significant growth in real wages at the all-India level over the past eight years.

On the contrary, the cost of healthcare and education is rising, most of which has to be borne privately. As per the latest household social consumption data (NSS 75th Round), only 4% of the rural population and 19% of the urban population reported that they had health expenditure coverage. According to the Economic Survey 2022-23, almost half of all medical expense is still borne by the patient themselves. 70% of India’s population who still reside in rural areas has to borrow more (25%) in comparison to their urban counterparts (18%) to meet their healthcare needs, driving an estimated 6 crore Indians into poverty, every year.

The government’s insurance coverage programme Ayushman Bharat, does not cover primary healthcare such as prenatal care, and other common diseases such as influenza and diarrhoea, which form a major part of household expenses on health. Even for the tertiary sector, and if one is lucky to get covered under government insurance coverage, new medicines for terminal illness diseases and surgical procedures remain outside the budget of a majority of the Indian household. For example, each round of chemotherapy and radiation costs more than Rs 1 lakh, whereas a vital organ transplant (liver and kidney) can cost anywhere between Rs 20 and 30 lakh. 

The same applies to quality education. At a time when public spending (Central and state governments taken together) is only 4.5% of GDP, it is not surprising that for a majority of the population, education is delivered by the private sector. Because of the failures of government schools to provide a decent education, studies show even the poor income households prefer sending their kids to private schools. The learning outcomes in government schools deteriorated post-pandemic. The ASER 2022 report flags widening learning gaps. Basic literacy levels of children have taken a big hit, with their reading ability compared with their numerical skills worsening sharply and dropping to pre-2012 level. However, sending kids to private schools cost money. As per a survey conducted by ET Online research, educating a child between the age of three to 17 years costs around Rs 30 lakh; a 4-year BTech or a 3-year BSc costs around Rs 4-20 lakh; and a five-and-half-year MBBS degree can cost up to Rs 1 crore.

No wonder in India, the middle class is getting squeezed.  

Nilanjan Banik is professor, School of Management, Mahindra University. He tweets @banik_nilanjan.

Does India Overtaking China in Population Call for a Party?

Policymakers unanimously lament the gross inadequacy of India’s education and healthcare infrastructure when it comes to creating a workforce which can reap the so-called demographic dividend.

There were mixed feelings when news came that India had gone past China’s population of 1,425 million. Of late, there has been creeping self-doubt, even in official policy circles, whether the much-vaunted “demographic dividend” would play out the way one had imagined.

In an ideal scenario, a growing young and educated working population should be a big advantage for any economy. A growing middle class consuming market also becomes attractive for the rest of the world in terms of trade and investment interaction. After all, two-thirds of India‘s population is under 35 years of age. And this advantage for India should continue for at least a decade after China’s population starts shrinking.

But this advantage can be leveraged only if certain conditions are fulfilled. One unfulfilled condition, which policymakers unanimously lament, is the grossly inadequate education and healthcare infrastructure to help create a workforce which reaps the so-called demographic dividend. There is enough literature analysing threadbare why India has not been able to fix its education and healthcare infrastructure, especially in the populous Hindi heartland states, which are decades behind even their south Indian counterparts – not to talk of any other country – in providing quality healthcare and education.

Remember, much of the so-called “demographic dividend” is supposed to accrue from these populous Hindi-speaking north and central Indian states. The southern states have begun mirroring the developed world in demographics, according to World Bank studies.

So the notion of demographic dividend is rather complex in the Indian situation and presents huge challenges. In this context, Chinese foreign ministry spokesperson Wang Wenbin echoed what many Indian policymakers have been saying for some time – an educated workforce is the key. Speaking about China, Wang said: “When assessing a country’s demographic dividend, we need to look at not just its size but also its quality. Size matters, but what matters more is talent resources. Nearly 900 million of the 1.4 billion Chinese are of working age and on average have received 10.9 years of education.”

China has managed to create a much larger educated and healthy work force than India. This clearly reflects in the sheer size of the consuming middle class in China compared with India.

Photo: diego.aviles/Flickr (CC BY-NC 2.0)

The US-based Pew Survey puts the Chinese middle and upper middle income population living on $10 to $50 a day at nearly 800 million in 2021. China achieved this in 40 years after the Deng Xiaoping reforms began.

In sharp contrast, Pew puts India’s middle and upper middle income population at merely 121 million. So, China’s middle and upper middle consuming class is over seven times that of India‘s. This ratio is directly reflected in the number of passenger cars sold in China and India in 2022. India sold 3.7 million passenger cars and China 26 million in the same year – over seven times. China’s GDP at nearly $18 trillion is six times that of India’s.

China’s economically empowered middle class is way bigger than India’s. India, too, has experienced rapid growth over 30 years of economic reforms, launched in 1991, but remains at the bottom 25% of economies in terms of per capita income.

In fact, the biggest bulge shown by the Pew Survey is in India’s low-income population living on  $2 to $10 a day. About 1.19 billion people live on $2 to $10 in India. This is the relatively low-income trap, mainly a result of 55% of the population remaining engaged in agriculture-related activities.

The last nine years have actually seen a backsliding as large numbers of people have moved back from urban employment to agriculture-related work, especially after the pandemic. This shows up in the permanently higher demand for the guaranteed rural employment programme. Moreover, reputed development economist Jean Dreze recently wrote in the Indian Express showing evidence gleaned from official labour surveys that rural wages have stagnated for many years. It is in this context that India crossing China’s population causes a sense of unease.

This piece was first published on The India Cable – a premium newsletter from The Wire & Galileo Ideas – and has been republished here. To subscribe to The India Cable, click here.