Doctors' group proposes one-child policy for India

Abstract

The Indian Medical Association has caused controversy by suggesting that India should adopt a Chinese-style one-child policy to help curb population growth. But opponents argue it is India's gender imbalance, not its birth rate, that needs urgent attention. Patralekha Chatterjee reports. India's soaring population—which the UN Population Fund estimates will overtake China's before 2030—will push the country into a state of “total anarchy” unless a one-child policy is implemented, Indian Medical Association (IMA) president Sudipto Roy has claimed. These remarks put the spotlight on a prickly issue for India, which pursued a policy of coercive population control, including forced sterilisation, during the Emergency era of 1975–76. Roy's controversial call for a one-child limit has been accompanied by a heated debate over whether the statement was a formal policy endorsement by the IMA, or the personal view of some members. “Several IMA members had recently gone to China. They were very impressed by China's achievements in slowing population growth, and expressed deep concern about our population explosion. They felt only strict measures would curb the population boom in India”, Roy explained to The Lancet. The IMA, he added, “is not an implementing authority. It is the government which has to decide how to curb population. Forcible sterilisation will boomerang as it did during the Emergency, but India should put in place a system that ensures everyone, regardless of religion, caste, and community, complies with the small-family norm.” India's most senior health bureaucrat, P K Hota, has been quick to make plain that the government does not favour coercive methods. At the state level, however, the situation is less clear. Several Indian states have policies that recommend the use of socio-economic tools to curb population growth. However, these policies are different to the penalty-centric Chinese model, which demographers argue would be hugely counter-productive in India's democratic society. “The one-child norm will not succeed in India. There is a cultural preference for sons and a one-child norm runs the risk of increasing female feticide, female infanticide, and even abandoning of girl children”, says S C Gulati, president of the Indian Association for the Study of Population. India has one of the most imbalanced gender ratios in the world: 933 girls for every 1000 boys (2001 Census). Female feticide and infanticide are largely responsible, despite laws banning sex-determination tests. Interestingly, affluent areas have the worst sex ratio. In southern Delhi, where the richest citizens live, the sex ratio is 780 girls per 1000 boys The country's best-known demographer, Ashish Bose, believes that while the public discourse focuses on India's soaring population, the really serious issue is the missing girls. He believes India's population problem remains unsolved because of misplaced priorities. An excessive emphasis on “family planning” and “contraceptive technology” lies at the heart of the country's rising numbers, he says. “If we had had no Emergency and no coercive family planning, we would have gone faster on the road to population stabilisation”, he explains. The southern state of Kerala, lauded for its achievements in population control, has succeeded not through coercion but by focusing on underlying factors and expanding literacy, education and primary health care for the masses. The National Population Policy (2000) acknowledges the huge need for health-care services and safe contraception in the country but to see the population challenge purely in terms of unmet demand for contraceptives is to miss the point. As Bose points out: “We are losing out because of the lack of a lifecycle or holistic approach. In a democracy when people want employment, drinking water, and literacy, one cannot distribute contraceptives and ask them to solve the population problem first.”