Shankerspeak: Better healthcare or ‘one child nation’ ?

India spends 1.26% of its GDP on public healthcare in contrast to China spending 5.35%, Canada 10.79%, UK 10% and the USA 17%. India thus needs better public health than laws restricting population

Shankerspeak: Better healthcare or ‘one child nation’ ?
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Abhijit Shanker

Indian women’s fertility rate declined from 2.82 to 2.2 in the 2008-18 decade, says the World Bank. This has been the sharpest decadal decrease since India’s independence, when it stood at 5.9. This decrease is the result of the work done by successive governments and the development aid sector, who have been working tirelessly to inform and educate Indians of the merits of family planning.

During the same time (2008-18), the infant mortality rates in India have climbed down from 47.3 to 28.3. The infant mortality rate is the number of deaths of children under one year of age per 1,000 live births. The global average of the number of infants dying within their first year of life is however just 8.

According to India’s Ministry of Health and Family Welfare in June 2020, only 11.5% of married couples in India used any form of modern contraceptive methods. Since India spends the lowest on public healthcare even in its own neighbourhood, does the country really need a family planning law?

China implemented its one child policy in 1979 and there are stories of the communist government razing houses of those who had more than one child and taking away the ‘excess’ children. In a recently hailed documentary, ‘One Child Nation’, the director and narrator, Nanfu Wang, takes us through a journey of her native land, the Jiangxi Province in China.

She tells us of her relatives, who had to abandon their babies and of her neighborhood which reeked of unwanted fetuses. Wang interviews old village chiefs, now in their late 70s, who helped spread the propaganda in China’s rural areas. They now seem full of regret, talking about the adoption agencies who would perpetually claim they had found the babies on their doorsteps and in the alleys.

The truth remained that these babies were taken from their mothers, their only fault being they were the second born. She also interviews an old midwife, who claims she performed more abortions and sterilizations than deliveries in the intervening years.


The documentary introduces us to a trafficker who claims he brought over 10,000 babies to orphanages, en route to being adopted abroad. It is estimated that over 130,000 babies were absorbed by the foreign adoption market. As you would perhaps imagine, most of the babies killed were girls. One would do well to remember that female infanticide plagues several states in India as well, even without a stringent family planning law in place. I shiver to imagine what might be the scenario should a law of this magnitude be ever implemented by a government in India.

As I watched the documentary, I thought to myself –could the Chinese government have used more effective strategies and policies than this barbarian law, which they reversed in 2015? It shows us the power of government propaganda, its hubris, its resolve to deviate from the problems it cannot solve for its citizens. It is an example of how not to conduct a family planning programme.

Other countries which have toyed with laws to enforce family planning include Vietnam and Iran. Vietnam had a population policy since the 1970s which stipulated the family size to two or three children, born 3-5 years apart, and recommended the mother’s minimum age to be 19.

A study conducted by A Johannson et al concluded that during 1983-93, the number of abortions in Vietnam increased from 6/100 women to 58/100 women. This experience tells us we need more behavioral change programmes rather than regulations which threaten its citizens out of jobs or benefits they are entitled to.

Iran’s experiment was less extreme. Right after the 1979 revolution, it encouraged its citizens to have as many children as they wanted to. However, it had to reverse its stand during the eight-year war with Iraq in the 1980s in the face of an economic recession. The Iranians were then discouraged to have more than two children. This suggestion, however, was never made into a law.

In different circumstances, some countries which are spending part of their GDP in persuading their citizens to have more children are France, Japan, Singapore (which had the ‘stop at two’ policy until 1980), and Turkey.


With one of the lowest birth rates in the world at .98 births per woman, the South Korean government ordered all its offices to switch off the lights at 7.30 pm every evening in 2010. The official responsible for this creative initiative, Choi Jin-Sun was quoted as having said that “Going home early may have no direct link to having more kids, but you cannot just completely rule out a possible link between them.”

Seven states in India — Andhra Pradesh, Bihar, Gujarat, Maharashtra, Odisha, Rajasthan and Uttarakhand — have laws barring couples with more than two children from contesting local body elections.

Assam and Uttar Pradesh have introduced laws, currently in various stages of adoption, for restricting benefits to be accrued by those having more than two children.

Rather than allowing this major policy to be influenced by election related rhetoric, the governments need to examine the progress that has already been made, study what could be done further to incentivise or educate couples and learn from the experiences of other countries who have either succeeded or reversed their policies.

(The author worked for the United Nations for more than a decade in New York, serving as UNICEF’s Chief of Communications)

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