Abstract
The discussion of fertility decline in Kerala state, India, focused on fertility decline in Kerala state and the role of the UN. Key features of Kerala's success in fertility decline were the emphasis on female education and the emancipation of women, reduced infant and child mortality rates, and political support. Since 1956 when the states of Cochin and Travancore were joined, the development of education and health services was encouraged. Literacy was over 90% in Kerala compared to 62% for males and 34% for females in India in 1990. Kerala's government invested in primary and secondary education, primary health care, and family planning services. 12% of Kerala's education budget is devoted to "higher" education compared to 47% of national government expenditures. Inheritance of property was matrilineal. 85% of girls aged under 14 years stayed in school in Kerala compared to 21% nationally. The mean age of marriage is 21.9 years compared to 18.3 years nationally. The sex ratio, life expectancy, and child mortality rates were favorable to females. In 1987 the crude birth rate was 22/1000 population in Kerala and 32/1000 nationally. The infant mortality rate was 27/1000 live births in Kerala and 94/1000 nationally. Contraceptive use in Kerala was predominately female sterilization, followed by the condom. Successful features of Kerala's fertility decline are potentially transportable to African countries where women already play an important role in trade and shopkeeping. Emphasis must be simultaneously placed on primary health care and free family planning services that are easily accessible at all levels of health care. With political will, African or poor countries should be able to afford these programs. The UN and its agencies should be the unifying force promoting and supporting education, primary health care, and family planning services on a worldwide scale. However, the authority and expertise within the UN has not been sufficient to meet this challenge.
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