Opinion Do we need a health ministry?

I wonder if the health minister has read Ashish Bose’s Head Count,published in 2010. If not,he should. And he should recommend that as mandatory reading to all MPs too,because he might obtain some new insights on demographic transition. But before Bose,no doubt the health minister knows that the First Five Year Plan document,in a chapter on health,had a sub-section titled “Family Planning”. This said: “The recent increase in the population of India and the pressure exercised on the limited resources of the country have brought to the forefront the urgency of the problem of family planning and population control… The main appeal for family planning is based on considerations of the health and welfare of the family. Family limitation or spacing of the children is necessary and desirable in order to secure better health for the mother and better care and upbringing of children. Measures directed to this end should,therefore,form part of the public health programme.”

Thus,way back in 1951,India was the first country in the world to talk about family planning. Everything that Azad wants now — late marriages,delayed first children,proper spacing — was on the agenda in 1951 too. The health ministry’s website,in the section on family welfare,has slogans like “Control Population” and “Have Fun with One”. This also has the National Population Policy,which tells us that in 1952 India was the first country in the world to introduce family planning.

Has this not worked and why has it not worked? A quote floats around,“Development is the Best Contraceptive”. It’s not very clear who first coined it. It may have been Dr Karan Singh,as minister for health and family planning,at the First World Population Conference in Bucharest in 1974. It may have been Indira Gandhi,or it may have been Ashish Bose. There may be high rates of population growth in some smaller states or union territories. But the key ones are larger states mentioned in the health minister’s letter — Bihar,UP,MP,Rajasthan and Orissa. In attitudes towards population bombs,one detects an element of paternalism on part of those who formulate policies and they are naturally those who aren’t poor. The poor don’t know what is good for them. They breed like rabbits. There must be coercive contraceptive practices. Hence,there is sneaky admiration for forcible sterilisation during the Emergency and China’s one-child policies. Such coercion not only distorts population pyramids,it also tends to be anti-women. We have had coercion after a fashion in panchayat elections in Haryana,Rajasthan,Andhra Pradesh,Orissa,MP and Himachal Pradesh and there are studies to show how these have restricted women’s choice. Therefore,there are understandable reasons why Maharashtra,Gujarat,Delhi and UP have not experimented with coercion.

Why is population a liability rather than an asset? Why was Ehrlich wrong? In part,because he failed to anticipate India’s Green Revolution. There is a second green revolution every prime minister and every government since 1991 have talked about. This includes Dr Manmohan Singh in several speeches and interviews. With a second green revolution,we should have no food security issues. Nor should we have issues connected with water,land,or other natural resources,and even urban planning. Unless we assume we won’t be able to reform and will continue to use land,natural resources and labour inefficiently,population shouldn’t be a problem. There is a quote ascribed to Mao,about every mouth coming with two hands attached. We can’t have it both ways. Logically,we can’t deride a large population and simultaneously salivate at the demographic dividend,which will accrue in the BIMARU states,with Orissa added. Implicit in paternalistic beliefs is a mindset that poor people aren’t productive. They don’t contribute to the GDP. Therefore,by extrapolation,murders of poor people are good for the cause of the GDP.

Since 1976,the Chinese adopted a policy of “later,longer,fewer”,which eventually became the coercive one-child policy. Surely,we don’t want to follow China in becoming a country that becomes grey before it becomes wealthy,with all its adverse consequences. As it is,India’s demographic dividend will whittle away beyond 2040. Of course,one wants “later,longer,fewer”,but that should be the outcome of natural and voluntary choice. BIMARU and Orissa fare ill on every development indicator — urbanisation,education (including women’s literacy),skills,physical infrastructure,drinking water,poverty,health (mortality,morbidity). Several of these are outside the health ministry’s ambit. But some,like infant mortality rate (IMR) and couple protection rates are under Azad’s purview. Why are IMR figures (for 2002) 61 in Bihar,85 in MP,87 in Orissa,78 in Rajasthan and 80 in UP? Why are couple protection rates 21.2 per cent in Bihar,45.9 per cent in MP,37.6 per cent in Orissa,36.1 per cent in Rajasthan and 38.0 per cent in UP? If there is going to be a debate in Parliament,let’s have one on why these numbers aren’t dropping fast enough. Let’s pin the health ministry down on outlays versus outcomes. If these are state subjects,let’s debate on whether we need a Central health ministry.

The writer is a Delhi-based economist

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