'It doesn't work': Why Assam's two-child policy plan is being criticised by public health experts

On Sunday, Assam’s health minister, Himanta Biswa Sarma, unveiled the draft of a new population policy for the state. It proposes, among other things, to penalise people who have more than two children. If the draft were to become law, they would be ineligible for government jobs and benefits, and be barred from contesting all elections held under the aegis of the state election commission.

“Assam is facing a dangerous population explosion, and this is one of the several measures we have proposed in the draft population policy,” Sarma said at a press conference in Guwahati.

The state has a population of 3.1 crores, according to the 2011 Census, up 46 lakhs from 2.6 crores in 2001.

The draft also suggests raising the minimum age of marriage for girls and making education free till the university level for all girl students in the state. It is currently open to inputs from the public. If it does become an Act, Assam will be the only state after Rajasthan to have a population policy of its own. The rest of the states follow the National Population Policy of 2000.

Targeting ‘illegal migrants’?

According to the 2011 Census, the Muslim population in Assam rose from 30.9% in 2001 to 34.2% in a decade. Analysts believe this move by the Bharatiya Janata Party-led state government is directed at Bengali-speaking Muslim immigrants in the state, who are perceived to have larger families.

This so-called illegal immigration from Bangladesh is a major political issue in the state. The BJP, which came to power in Assam last year, had made the detection and eviction of all illegal Bangladeshi migrants a major poll promise.

Hafeez Ahmed, a social activist and academic, who works in the chars – the densely populated sand bars in the middle of the Brahmaputra river – accused the government of targeting particular communities. “The policy of leaving out people from government jobs, benefits and elections is unconstitutional and violates the fundamental rights of citizens,” he said.

Assam’s under-five mortality rate – the number of children under the age of five years dying per thousand live births – is 56, higher than the national average of 50. In the Bengali-Muslim dominated chars, the number, according to a recent study, is more than double at 136.9. The fertility rate in the areas surveyed was also found to be higher than the state average.

Notably, the study also revealed that more than half of the households were illiterate, 91% did not have access to safe drinking water while only 1.4% had sanitary latrines within the premises of their homes. Ahmed accused the government of targeting such vulnerable populations without addressing the primary issues of illiteracy and poverty.

Is it unconstitutional?

Illias Ali, a surgeon and member of the committee that drafted the policy, defended the coercive measures. “The situation is such that there is a need for drastic measures,” said Ali, who once had a fatwa issued against him for advocating the value of family planning among Muslims.

Ali, a vasectomy specialist, said the policy should be seen in its entirety. “The focus in the draft is on empowering women with education and curbing child marriage,” he claimed. “The minister mentioned about the coercive measures in the press conference, so everyone’s just talking about that.”

According to Supreme Court lawyer Nilay Dutta, the provisions of the policy are not necessarily unconstitutional. “There have been instances in the past when the courts have upheld restrictions on the basis of education for contesting elections,” said Dutta. “As far as jobs go, courts have, in the past, upheld a state government’s decision to declare a person ineligible if he has more than one wife, too.”

But Dutta was sure that if the final draft of the policy read exactly the same as the current one, someone would move court. “There is always a debate between what a law ought to be, and what it is. Just like the legislature has the right to make laws, citizens are free to challenge it in courts,” he explained.

‘Obsolete, anti-poor’

According to public health experts, coercive measures such as those prescribed in the draft policy will not help arrest population growth.

“A two-child approach to family planning is absolutely counter-productive and obsolete,” said former Union Health Secretary AK Nanda, who was part of the drafting committee of the National Population Policy, 2000. “It is an ill-conceived measure and the government should instead focus on improving healthcare services in rural areas and make contraceptives available in the remote corners of the state.”

Poonam Muttreja, executive director at the Population Foundation of India, also denounced the draft, saying “coercion is never the answer”. “India’s family planning programme has never quite recovered from the setback of the forced sterilisation drive of the 1970s,” she said. “Coercive measures violate a couple’s prerogative to a rights-based approach to family planning, and indicate that numbers matter more than people do.”

The draft policy’s proposals for family planning, she said, were “undemocratic”, “discriminatory”, “anti-women”, “anti-poor” and “compromised human rights”.

Nanda agreed. “What it will do is disempower rural women and prevent them from taking part in panchayat elections,” he said. “All other states that had a two-children policy have withdrawn it because it simply doesn’t work.”

Reproductive health, not population control

In the 1970s, India had embarked on a forced sterilisation drive to curb the high rate of population growth. In the late 1990s, though, it changed track. The emphasis shifted from population control to sexual and reproductive health and rights. The National Population Policy of 2000 reflects this change. It underlines the “commitment of the government towards voluntary and informed choice and consent of citizens while availing of reproductive healthcare services, and continuation of the target free approach in administering family planning services”.

But states like Uttar Pradesh, Rajasthan, and Madhya Pradesh continued, for a long time, to have laws barring men and women with more than two children from contesting panchayat elections. “We have seen an increase in sex-selective abortions, women being deserted, women giving their children up for adoption, and stigmatisation of a third child in those states,” claimed Muttreja.

Edward Premdas Pinto, director, research and advocacy, at the Centre for Health and Social Justice, agreed that the policy was misdirected. “The fertility rate is already on the decline; this wasn’t necessary at all,” he said. “It would lead to more physical and emotional violence against women, who would be under even more pressure to produce male children now.”

A far better way to check population growth, experts suggest, is to check infant mortality. “There is evidence to support the assumption that high mortality rate causes concern about the chances of survival of children leading to a tendency of having more children,” explained Muttreja. “In Bangladesh, data has shown that if no child had died in a family the fertility rate was 2.6 children; when one child died, the number was 4.7 children; two child deaths meant 6.2 children; and more than 3 child deaths increased it to 8.3.”

Pinto felt that Assam should have instead taken a cue from Kerala, which managed to significantly lower its fertility rate without employing any coercive tactics. “The Kerala government focused on literacy and making healthcare accessible to all, and the results are for all to see,” he said. “If the government can ensure quality post-natal care and the survival of children, people will automatically stop having big families.”

To find out how coercive measures for population control have worked, one need look no further than China, Muttreja pointed out. The country, which had a strict one-child policy for 35 years, is still grappling with population problems.