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Chapter 5 H H
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Introduction development in any state are direct functions of its

population dynamics. Public expenditure on provision
Among all resources available in any society,
of health, education, employment, energy, environment,
‘people’ or human resources are valued as the most
transport, technology, communication and social
fundamental. Human resource is critical because
security services are largely determined by the quality
utilisation of other resources, such as land, capital and
and quantity of human population. Besides, in the era
organisation depends, inter alia, to a large extent on the
of liberalisation, demographic dynamics of the
nature of human beings. The current paradigm of
population of a nation also affects the process of
development focusing on ‘quality of life’ puts people at
globalisation. Favourable changes in the population
the core of planning for reasons of equity, efficiency
structure boost economic growth and influence the
and dignity. Human development, defined as an
movement of people, products, and investment capital
expansion of human capabilities, widening of choices,
among countries (La Croix et al. 2003).
enhancement of freedom and fulfillment of human
rights, has come to be accepted as the new model of The development of national human resources in
development, instead of a mere rise in incomes and India is contingent upon the population stabilisation
growth in outputs (Fukuda-Parr and Kumar 2003). goals at a sustainable level (National Commission on
Hence, the essence of human resource development Population 2001, Planning Commission). In India, three
involves broadening the horizons of quality, so as to broad themes of the Tenth Five Year Plan, namely,
transform ‘population’ to ‘people’. A nation is its a) growth, poverty and employment, b) social develop-
people, and in the ultimate analysis, all development ment, and c) sustainability of growth and development
must benefit people, individually as well as collectively. revolve around the human resource component. The
final assessment of the development process, or for that
Human resource development is intimately tied to matter any plan, lies in the way it alleviates deprivation
population dynamics, more so in South Asia, where and enhances the well-being of human beings. Appraisal
high fertility, rapid population growth and high of existing human resources in Himachal Pradesh in a
dependency ratios make economic growth and human demographic perspective not only helps in understanding
resource development relatively more difficult (Jones the assets and liabilities in launching plan efforts but
1992). Population growth and distribution patterns are also in setting targets for achievements and deciding
also essential to understand the human resource assets, priorities in policy formulation and programme
their values and potential use. In addition, demographic implementation. Examination of demographic dimensions
changes have direct as well as indirect implications for is essential because development cannot be assessed in
human resource development, which are complex and terms of generation of economic growth alone. In order
synergic (Jones 1992). To elaborate, higher infant to be more meaningful, it has to address the key
mortality means more requirements of health care objective of reduced population growth, social
services; larger working age population cause pressures integration, removal of disparities, economic
to create gainful employment; and increasing life empowerment and also protection of environment.
expectancy may induce more social security measures. Profiling of population in the state helps to identify
Implications, goals and strategies of human areas that need policy and programme interventions, to
86 HIMACHAL PRADESH DEVELOPMENT REPORT
set near- and far-term goals, and to decide priorities, cent during 1971-1981. The last decade of the twentieth
besides understanding them in an integrated structure. century recorded definite signs of deceleration in the
momentum of population growth in Himachal Pradesh,
This chapter deals with the overall demographic
with the mean annual growth rate (1.75%) falling not
situation in Himachal Pradesh, the scope being
confined to salient features in demographic development only below the ‘standard’ two per cent mark but also to
pre-1951 level. Much of this population expansion in the
in a framework of inter-state comparison, elements of
state has been indigenous, as the contribution of in-
population change and focus on future population
perspectives. Based on data from several sources, within migration from other states in India and from countries
outside India was insignificant. To quantify, the share of
and outside government, it covers a range of issues,
such international and interstate migrants in total
such as population structure, fertility, mortality, family
planning, ageing, sex preference, sex-ratio imbalances population of the state in 1991 varied between 2.7-5.2 per
cent depending on the definition of migration adopted in
and others. It summarises the population dynamics in the
the census, and it is unlikely that this component will
state since its creation till the beginning of the twenty-
first century and highlights the demographic dimensions alter substantially in the 2001 census. In the inter-censal
period 1991-2001, the households in Himachal Pradesh
of development through an independent review.
enlarged from 0.969 million to 1.241 million growing by
Population Change 28 per cent and the average size of households reduced
to 4.9 persons from 5.4 persons, recording the impact of
States in India are experiencing demographic declining population growth rate.
transition, the routes of transition being determined
largely by local living conditions. Changes in the natural Population size is one of the key determinants of
increase of population, brought about primarily by the labour force and its participation rates. With young-
age population declining due to fertility reduction and
declining fertility and mortality, suggest that Himachal
Pradesh is no exception to this demographic transition. the old-age population not rising commensurately to
Such transition, along with forces of migration, is offset this fall, it is often said that the countries enjoy
‘Demographic Bonus’ during the course of demographic
affecting population size, age structure, sex composition
and distribution patterns that are important indicators of transition. In a free market, greater size of workforce
human resources in the state. According to the 2001 released from transitional population can make
production cost-effective and the economy more
Census, the state accounted for a meagre share of the
total population of India (0.59%), the same as its share competitive, provided appropriate and timely education,
in 1991. The total population in the state grew from 1.9 health and skill investments are undertaken to effect
better capability.
million in 1901 to 6.1 million in 2001, making a net
addition of 4.2 million in the twentieth century. In three The age structure of the population, on the one
decades, since Himachal Pradesh attained full statehood, hand expresses demographic dimensions of
a little more than a quarter million (2.6) was added to development, and on the other delineates the challenges
its population. The average annual population growth for development. On the basis of selected age and sex
rate crossed the two per cent mark and peaked at 2.37 per structures, Table 5.1 outlines some planning imperatives
TABLE 5.1
Human Resources, Himachal Pradesh (1971-2001)
Year Total Reproductive Age Women Working Age Population Aged Population Population Child Population
Population (15-44 years) (15-59 years) (60 plus) (7-14 years) (0-6 years)
Male Female (in ’000) % Share in (in ’000) % Share in (in ’000) % Share in (in ’000) % Share in (in ’000) % Share in
(in ’000) (in ’000) Total Female Pop. Total Pop. Total Pop. Total Pop. Total Pop.
1971 1767 1693 725 42.8 1786 51.6 248 7.2 725 21.0 701 20.3
1981 2170 2111 920 43.6 2264 52.9 321 7.5 892 20.8 802 18.7
1991 2617 2553 1176 46.0 2898 56.0 421 8.1 998 19.3 840 16.2
2001 3085 2992 1418 47.4* 3519 57.9* 607 10.0 1118 18.4 769 12.7
Source: 1. Socio-cultural Tables, Census of India 1971, 1981, 1991, Himachal Pradesh.
2. Population Totals, Paper 1 of 2001, Census of India 2001, Himachal Pradesh.
Note: * Indicates that the figures are estimated.
Chapter 5 • POPULATION 87
in human development that emanate from demographic large extent. As a result of socio-economic development
effects in Himachal Pradesh. The growth of female and family planning intervention, India recorded
population in the reproductive age group (15-44 years) significant fall in fertility, fairly widespread across the
in both absolute and relative senses reinforces the need states, in the post-independence period. Yet, regional
for levels of investment in health, nutrition and related variations have continued in the onset and speed of
areas. In the same way, the growth in the workforce fertility transition in the country. In the north,
from 1.79 million (52% of total population) in 1971 to Himachal Pradesh has undergone substantial
3.52 million (58% of total population) in 2001, raises transformations in its fertility profile during the last
questions on provisions for productive employment and three decades of the twentieth century.
opportunities for gainful participation in economic
activity. The result of fertility decline is manifested in Levels and Trends
the shrinking child population in the age group 0-6 Fertility has been consistently falling in Himachal
years. The drastic decline in the number of such young Pradesh, as indicated by trends in total fertility rates
age groups (by 8.5%) from 0.84 to 0.77 million in the (TFRs) since the beginning of the 1970s for major
last decade is attributed to fall in fertility and may Indian States (Table 5. 2, Figure 5. 1). Though the
initiate the need for rethinking on resource allocation for southern states are ahead in fertility transition and
education and other factors for the needs of the younger have total fertility rates lower than the northern
generation. Additionally, the implications of life cycle counterparts, Himachal is a classic case that blurs this
and changing age structure for consumption, saving, north-south divide. The decline in fertility seems to
investment, etc., as indicated above, need to be factored have accentuated in the 1980s as compared to the 1970s,
into planning perspectives in Himachal Pradesh. and remained consistent till the end of the 1990s.
The decline in fertility is reasonably widespread in
Fertility Transition
the state and is not confined to any specific region or
Limiting population growth in India is at the top of community. Individual districts along with rural and
the national agenda and the goals set in the National urban areas are experiencing transition in fertility in
Population Policy 2000 (NPP 2000) mirrors this to a different ways, depending on changes in local
TABLE 5.2
Fertility Decline in Major States, India (1970-72 to 1997-1999)
State Total Fertility Rate (TFR) Per cent Decline in TFR

1970-72 1980-82 1990-92 1997-99 1971-81 1981-91 1971-91 1991-98 1971-98
A.P. 4.7 3.9 3.0 2.4 17.0 23.1 36.2 20.0 48.9
Assam 5.5 4.1 3.4 3.2 25.5 17.1 38.2 5.9 41.8
Bihar — 5.7 4.6 4.4 — 19.3 — 4.3 —
Gujarat 5.7 4.4 3.2 3.0 22.8 27.3 43.9 6.3 47.4
Haryana 6.4 5.0 3.9 3.3 21.9 22.0 39.1 15.8 48.4
H.P. 4.7 4.0 3.1 2.4 14.9 22.5 34.0 22.6 48.9
J & K 4.8 4.4 3.3 — 8.3 25.0 31.3 — —
Karnataka 4.4 3.6 3.1 2.5 18.2 13.9 29.5 19.4 43.2
Kerala 4.1 2.9 1.8 1.8 29.3 37.9 56.1 0.0 56.1
M.P. 5.7 5.2 4.6 3.9 8.8 11.5 19.3 15.2 31.6
Maharashtra 4.5 3.7 3.0 2.6 17.8 18.9 33.3 13.3 42.2
Orissa 4.8 4.2 3.3 2.9 12.5 21.4 31.2 12.1 39.6
Punjab 5.3 4.0 3.1 2.6 24.5 22.5 41.5 16.1 50.9
Rajasthan 6.3 5.4 4.5 4.2 14.3 16.7 28.6 6.7 33.3
Tamil Nadu 3.9 3.4 2.2 2.0 12.8 35.3 41.0 9.1 48.7
Uttar Pradesh 6.7 5.8 5.2 4.7 13.4 10.3 22.4 9.6 29.9
West Bengal — 4.2 3.2 2.5 — 23.8 — 21.9 —
INDIA 5.2 4.5 3.7 3.2 13.5 17.8 28.8 13.5 38.5
Source: Statistical Report (different volumes), Sample Registration System (SRS), Registrar General, India.
Note: — Indicates data not available.
conditions, which often act as important inducements FIGURE 5.1

for the determination of family size. Substantial fertility Total Fertility Rate, India and Himachal Pradesh
reduction in Himachal Pradesh, despite some of the key (1971-73 to 1997-99)
6
social indicators, such as emerging son preference,
Total Fertility Rate

5
sizeable presence of socially backward population and
4
relatively higher infant mortality being against the
3
decline, is a manifestation of the primacy of intervention
2
by selected development factors, namely, the family
1
planni ng programme, female literacy, health care
delivery and financial prosperity at the household level. 0
1971-73
1972-74
1973-75
1974-76
1975-77
1976-78
1977-79
1978-80
1979-81
1980-82
1981-83
1982-84
1983-85
1984-86
1985-87
1986-88
1987-89
1988-90
1989-91
1990-92
1991-93
1992-94
1993-95
1994-96
1995-97
1996-98
1997-99
Studies to assess the role of economic aspirations,
family systems and social status indicators in the
Year
fertility transformations, are virtually non-existent.
India (total) H.P. (urban)
H.P. (total) H.P. (rural)
TABLE 5.3 Source: Statistical Report (different volumes), Sample Registration System ,
Registrar General, India.
Crude Birth Rate (CBR) and Total Fertility Rate (TFR),
India and Himachal Pradesh (1971-73 to 1999-2001)
Replacement Level of Fertility
Period India Himachal Pradesh With fertility falling significantly in Himachal
CBR TFR CBR TFR Pradesh during the last three decades of the twentieth
Total Total
Total Rural Urban Total Rural Urban century, it is appropriate to look at the far-term
1971-1973 36.3 5.1 36.0 36.8 23.5 4.9 5.0 2.9 prospects of reaching the replacement level. Since
1972-1974 35.3 5.0 35.2 36.0 23.3 4.7 4.8 2.8 achievement of replacement-level fertility is crucial for
1973-1975 34.8 4.9 35.0 35.9 22.2 4.7 4.8 2.6 the long-term objective of ‘Stable Population’ by 2045
1974-1976 34.4 4.8 33.3 34.1 21.9 4.4 4.5 2.6
in India, and the medium-term objective of reducing the
1975-1977 34.2 4.7 32.5 33.3 20.8 4.3 4.4 2.5
total fertility rate (TFR) to replacement level by 2010,
1976-1978 33.3 4.6 30.7 31.4 21.8 4.0 4.1 2.5
1977-1979 33.1 4.5 30.5 31.2 21.2 3.8 3.9 2.4
as laid down in the National Population Policy 2000 (NPP
1978-1980 33.3 4.4 30.2 30.6 21.2 3.7 3.8 2.4 2000), it is pertinent to examine the position of
1979-1981 33.8 4.4 31.6 32.2 19.2 3.8 3.9 2.2 Himachal Pradesh in relation to the national target.
1980-1982 33.8 4.5 32.0 32.8 20.0 4.0 4.1 2.3 Recent indications do signal the possibility of the state
1981-1983 33.8 4.5 32.3 33.1 20.8 4.0 4.1 2.4 reaching the replacement level by the year 2010.
1982-1984 33.8 4.5 32.1 32.7 22.9 4.0 4.1 2.6
Himachal Pradesh is yet to attain the replacement level
1983-1985 33.6 4.4 31.3 31.9 23.2 3.9 4.0 2.6
1984-1986 33.2 4.3 30.5 31.1 22.4 3.7 3.8 2.5
of fertility. National Family Health Survey (NFHS)
1985-1987 32.6 4.2 30.5 31.1 22.2 3.6 3.7 2.4 estimates the state’s fertility to be two per cent above
1986-1988 32.1 4.1 31.2 31.9 21.8 3.6 3.7 2.4 the replacement level as against the SRS (1999) estimate
1987-1989 31.5 4.0 30.2 30.8 22.0 3.5 3.6 2.4 of 13 per cent and MICS (2000) estimate of 25 per cent.
1988-1990 30.8 3.9 29.1 29.7 21.0 3.3 3.4 2.3 According to NFHS, urban areas have fertility 20 per
1989-1991 30.1 3.8 27.9 28.5 19.6 3.1 3.2 2.1
cent below the replacement (TFR being 1.74), whereas in
1990-1992 29.6 3.7 28.0 28.6 19.5 3.1 3.2 2.1
the rural areas fertility (TFR being 2.18) remains four per
1991-1993 29.1 3.6 27.8 28.5 19.6 3.0 3.1 2.1
1992-1994 30.4 3.5 27.0 27.6 19.6 2.9 3.0 2.1
cent higher than the replacement level. With nearly
1993-1995 29.9 3.5 26.0 26.6 18.8 2.8 2.9 2.0 nine-tenths of the population still living in villages that
1994-1996 27.4 3.3 24.8 25.4 17.7 2.7 2.8 1.9 are very much scattered and remote, the prospects of
1995-1997 27.7 3.4 23.6 24.1 17.3 2.5 2.6 1.8 stabilising the population in Himachal Pradesh in near
1996-1998 27.1 3.3 22.7 23.2 17.0 2.4 2.4 1.8
future depends on the success of the efforts in rural
1997-1999 26.6 3.2 23.0 23.5 16.9 2.4 2.4 1.8
areas. This foreseeable task is worth undertaking given
1998-2000 26.1 — 22.8 23.3 16.9 — — —
1999-2001 25.7 — 22.3 22.7 16.8 — — —
volume of unwanted fertility in the state, estimated to
be 30 per cent of total fertility (NFHS 2002).
Source: Statistical Report (different volumes), Sample Registration System
(SRS), Registrar General, India.
Age Pattern of Fertility
Note: 1. Rates for India exclude Mizoram till 1995, and Jammu and
Kashmir from 1991 onwards.
The age pattern of childbearing in Himachal Pradesh
2. — Indicates data not available.
has undergone a change during the closing decades of
the twentieth century, with fertility limitation being FIGURE 5.2

increasingly common at relatively old ages. Though fall Age-specific Fertility Rate, Himachal Pradesh (1981-1999)
in fertility has been observed among women in all ages
350
between 1981 and 1999, the contribution to the fertility
Age-specific Fertility Rate

300
decline has been mostly from women in very early (age
15-19) as well as late reproductive years (age 30-34), 250
according to the SRS (Table 5.4, Figure 5.2). Two 200
successive rounds of NFHS, recording a rapid fall in 150
fertility in Himachal Pradesh during the 1990s, higher 100
than the national decline, also document lesser 50
contribution by younger women (age 15-29) than by 0

older women (age 30-44) to overall decline in fertility. 15-19 20-24 25-29 30-34 35-39 40-44 45-49
Both the SRS and NFHS report almost no childbearing 1981 1991 1995 1999
among women in the age group 44-49 years. Relatively

Source: Statistical Reports (different volumes), Sample Registration System
less enthusiasm by women in the age group (20-29 (SRS), Registrar General, India.
years) in limiting fertility can be attributed to social
and cultural reasons that stress the need for child-
varies most according to economic and social
bearing immediately after marriage to establish fertility
backgrounds. In Himachal Pradesh, fertility differentials
potential. Child-bearing, coming shortly after marriage,
are sharp when groups are compared in terms of
is mainly concentrated in 20-24 and 25-29 age groups,
selected economic and social background characteristics.
which account for 47 and 30 per cent of the births
As seen from the recent round of NFHS, variations in
respectively, in the entire reproductive period of women
fertility (measured in terms of differences in total
(NFHS 2002). Such concentration of births is more
fertility rates, current pregnancy rates, and mean
severe among rural than urban women in Himachal
number of children ever born to women in 40-49 age
Pradesh: 78 per cent in rural areas as against 71 per
group) according to the standard of living in the
cent in urban areas. Interestingly, between 1990-92 and
household, educational attainment of women, place of
1996-98, the contribution of women aged 20-29 years
residence of the family, religion and caste-status of the
to overall fertility increased from 73 per cent to 78 per
household, are striking. For instance, the TFR of
cent (NFHS), and is a pointer to changing reproductive
women in households with a low standard of living
strategies of Himachali couples, who do not want to
(2.49) is nearly 1.3 times higher than their
prolong childbearing and finish it as quickly as possible
counterparts with a high standard of living (1.89); for
in response to larger social and economic changes.
illiterate women (2.85) it is 1.4 times higher than that
of women with education of high school and above
TABLE 5.4 (2.04). Women in urban areas also report 40 per cent
Age-Specific Fertility Rates (ASFRs),
lower TFR (1.74) than women in villages (2.18). Since
Himachal Pradesh (1991-1999) there exists a great degree of concurrence between caste
status and economic well-being, inequality in the
Age group (in 1981 1991 1995 1999 Per cent decline in
completed years) ASFR(1981-99)
economic sphere often gets translated into demographic
outcomes. In Himachal Pradesh, women from Scheduled
15-19 68.6 69.2 28.4 24.8 63.8 Caste, and other backward caste women, including the
20-24 301.8 271.9 245.9 236.6 21.6
Scheduled Tribe women, record higher levels of TFR
25-29 193.3 169.0 180.9 161.2 16.6
30-34 133.0 69.8 59.6 49.9 62.5 (2.15 and 2.37 respectively) as against the women from
35-39 55.2 34.6 20.6 14.0 74.6 other castes (2.05). The pregnancy rate is substantially
40-44 9.4 8.5 6.9 1.4 85.1 higher among Scheduled Caste women (5.1) than
45-49 0.0 1.5 1.4 0.0 0.0 among women from other backward caste (4.2) and
Source: Statistical Report (different volumes), Sample Registration System non-backward populations (4.0). Variations in fertility
due to religious beliefs are of less consequence in
Himachal Pradesh, as Hindus alone account for
Fertility Differentials approximately 96 per cent of the total population,
according to the 1991 Census. According to the NFHS,
Social and economic conditions considerably
demographic reflections of social inequalities are clear
determine the course of fertility transition, as fertility
and still persist. Also, over time, there has been little and the National Health Policy 2002 (NHP 2002) have also
change in relative positions of communities by social or simultaneously reinforced the need for mortality decline.
economic class in terms of the respective contribution Programmes are afoot at the national as well as state
to overall fertility, though the major social and levels to improve overall survival conditions, as a result
economic groups have shown a decline in current of which mortality decline is visible among segments of
pregnancy rates and fertility. population in most of India. A dramatic fall in mortality
has been also recorded in Himachal Pradesh during the
Prospects for Further Decline last three decades of the twentieth century.
Pathways to fertility decline are complex, changing
and non-universal. As fertility declines in a variety of Levels and Trends
situations, generalisations about social, cultural and In Himachal Pradesh, data show that the crude
economic causes of fertility decline are not easy and death rate (CDR) declined from around 15 deaths per
seldom necessary. However, routes to lower fertility in 1,000 population in the early seventies, to seven deaths
different settings have been historically documented and per 1,000 population at the beginning of twenty-first
have extensively improved the understanding of century (Table 5.5). This reduced mortality is an integral
reproduction patterns. In the absence of systematic part of the demographic transition in the state (Figure
explorations of receding fertility in Himachal Pradesh 5.3), and has extensively contributed to increase in life
with a focus on dimensions of development and expectancy at birth and at other ages. Though overall
mechanisms of influence, existing evidence point to mortality in Himachal Pradesh has been consistently
overall effects of sustained economic prosperity, relatively lower than the national average, yet, over time, the
less gender disparity, impact of a strong family planning advantage that the state initially had, in terms of lower
programme, greater access to health care services, probability of death, has remained substantially
superior infrastructure in terms of housing and basic unchanged, except for some fluctuations in the late
amenities, improved exposure to education and seventies and eighties. For example, in little less than
communication, better literacy among males and females, three decades, the advantage of Himachal Pradesh over
and more recently termination of pregnancies, etc. the national mortality situation remained almost same,
While it is important to acknowledge the fact that from 14.0 per cent in 1972-74 to 15.3 per cent in 1999-
fertility has fallen considerably since the early seventies, 2001. Both rural and urban areas gained consistently
despite the constraints of a mountainous state, it is from the onset of mortality decline, even if rural death
more useful to explore the prospects of further decline rates continue to exceed urban death rates for a variety
in the near future. The key to this lies in eradicating of reasons in Himachal Pradesh, as elsewhere in India.
the existing strong son preference, in lengthening the Comparison of NFHS results between 1991-92 and
interval between two successive births, spreading out 1997-98 also supports the declining trend in overall
childbearing among women aged 20-29, raising the death rates in Himachal Pradesh.
female median age at marriage beyond the current level
of 18.6 years, wiping out early marriage, reduction in Age-specific and Sex-specific Death Rate
the current level of infant mortality, augmenting In addition to the rural and urban variations, the
contribution by socially and economically poor sections mortality situation is also better understood through
of the society, progress in eliminating the unmet needs its sex composition and age pattern. Over the years,
for contraception, change in reproductive strategies notwithstanding the early-age vulnerability to death,
among younger couples and finally overall advance in gains from mortality decline are distinct among males
living conditions. and females in Himachal Pradesh (Table 5.6), with net
gain to males surpassing that to females in the process
Mortality Change of mortality transition. In fact, a notable feature of
Reduction in overall mortality is an important mortality transition in Himachal Pradesh between 1981
objective of planning since the First Five Year Plan. and 1999 has been larger gains for the males than for
Continued commitment to essential primary health care, females in general, as evident from the overall gap in
provision of emergency and other life services in the CDR between males and females. The narrowing down
public domain during the Tenth Five Year Plan (2002- of sex differentials in mortality in 1999, as against
2007) are pointers towards this (Planning Commission 1971, seems to have been the result of comparatively
2001). The National Population Policy 2000 (NPP 2000) slower gain to females both in rural and urban areas.
The age-specific mortality curve for Himachal

TABLE 5.5
Pradesh was the usual ‘U’-shaped in 1981 and 1998,
Crude Death Rates (CDR), India and Himachal Pradesh due to relatively higher mortality rates at young and old
(1971-73 to 1999-2001)
ages. Though, for nearly two decades, the mortality
Years India Himachal Pradesh Total Comparative pattern by age remains broadly the same, significant
Total Mortality Advantage of
H.P (in per cent)
changes seem to have taken place in the death of
Total Rural Urban
different segments of the population. For most of the
age groups, a drop in mortality is reported by SRS
1971-1973 15.9 14.6 15.1 6.9 8.2
between 1981 and 1999, irrespective of sex, with some
1972-1974 15.7 13.5 13.9 6.9 14.0
1973-1975 15.3 12.6 13.0 7.3 17.6
exceptions (Table 5.6). Mortality rate at the early age
1974-1976 15.0 13.0 13.4 7.1 13.3 (0-4 years) of life has strikingly plummeted down for
1975-1977 15.2 12.8 13.2 6.5 15.8 males in urban and rural areas, unlike that for female
1976-1978 14.5 12.3 12.7 6.3 15.2 children in the same age group, for whom mortality
1977-1979 13.9 11.3 11.5 5.9 18.7
conditions have improved more slowly. This change
1978-1980 13.1 10.9 11.2 6.1 16.8
1979-1981 12.7 10.6 11.0 5.6 16.5
between 1981 and 1999 in the state has significant
1980-1982 12.3 10.3 10.7 5.2 16.3 policy and programme implications. In the reproductive
1981-1983 12.1 10.3 10.6 5.3 14.9 age group (15-44 years) too, where the risks of child-
1982-1984 12.1 10.0 10.3 5.7 17.4 bearing decisively enhance female exposure to death,
1983-1985 12.1 10.4 10.6 6.4 14.0 the gains have been recorded in Himachal Pradesh,
1984-1986 11.8 9.8 10.0 6.7 16.9
1985-1987 11.3 9.2 9.4 6.3 18.6
particularly in rural areas. The NFHS findings also
1986-1988 11.0 8.9 9.1 5.9 19.1 broadly support the SRS pattern in Himachal Pradesh.
1987-1989 10.7 8.9 9.2 5.5 16.8 Comparison of first (1992) and second round (1999)
1988-1990 10.3 8.9 9.1 6.0 13.6 results indicates a halt to improvement in child
1989-1991 9.9 8.7 8.9 6.1 12.1 mortality, and decline in mortality among women in the
1990-1992 9.9 8.7 9.0 5.6 12.1
reproductive age group in the state.
1991-1993 9.7 8.8 9.1 5.2 9.3
1992-1994 9.5 8.7 9.0 5.3 8.4 Notwithstanding annual fluctuations in age-specific
1993-1995 9.2 8.6 8.9 5.8 6.5
death rates as reported by the SRS, it is apparent from
1994-1996 9.1 8.4 8.6 5.9 7.7
Table 5.6 that at some specified ages, the sex of the
1995-1997 9.0 8.3 8.5 6.0 7.8
1996-1998 9.0 7.9 8.1 5.8 12.2 individual is one of the important indicators of
1997-1999 8.9 7.7 7.9 5.5 13.5 exposure to death. While female mortality-disadvantage
1998-2000 8.7 7.4 7.6 5.4 14.9 is likely during childhood (>5 years), male vulnerability
1999-2001 8.5 7.2 7.3 5.3 15.3 begins to mount from the age of 35 onwards.
(SRS), Registrar General, India. Infant, Child and Under-five Mortality
Infant mortality is a significant indicator of human
FIGURE 5.3 development as it indicates whether development has
Demographic Transition in Himachal Pradesh really trickled down. In view of the fact that children
(1971-1973 to 1998-2000) below five years typically have higher probability of death
40
in Indian circumstances, infant and childhood mortality-
35
reduction goals have continued to be a national priority
CBR/CDR/CRNI
30
since the First Five Year Plan (Planning Commission,
25
20
1952). The Tenth Five Year Plan is also committed to
15 strategies to ensure better survival of children and
10 bridging gender differences in early age mortality
5 (Planning Commission 2003). The Millennium Development
0 Goals (1990-2015) also emphasi ses the urgency of
1971-73
1972-74
1973-75
1974-76
1975-77
1976-78
1977-79
1978-80
1979-81
1980-82
1981-83
1982-84
1983-85
1984-86
1985-87
1986-88
1987-89
1988-90
1989-91
1990-92
1991-93
1992-94
1993-95
1994-96
1995-97
1996-98
1997-99
1998-00
reducing the under-five mortality rate by two-thirds. The

National Population Policy 2000 (NPP 2000) and the
CDR CBR CRNI National Health Policy 2002 (NHP 2002) also address the
Source: Statistical Reports (different volumes), Sample Registration System
issues of child health and survival and have set the IMR
(SRS), Registrar General, India. reduction goal of 30 per 1000 live births by 2010.
TABLE 5.6
Age-specific Death Rates (ASDR) by Sex, Himachal Pradesh (1981 and 1999)
1981 1999
Age (in Male Female Male Female
completed years) Rural Urban Total Rural Urban Total Rural Urban Total Rural Urban Total
0-4 21.6 15.9 21.4 17.5 11.3 17.2 13.7 8.0 13.4 12.9 7.7 12.6
5-9 0.8 1.2 0.9 0.4 0.0 0.4 0.7 0.0 0.7 1.3 1.5 1.4
10-14 0.0 0.0 0.0 0.0 0.0 0.0 0.6 0.0 0.6 0.3 0.0 0.3
15-19 0.0 0.0 0.0 0.0 0.0 0.0 0.1 1.3 0.2 0.8 0.7 0.8
20-24 0.0 3.3 0.3 4.8 2.2 4.7 0.9 1.5 0.9 1.0 0.0 1.0
25-29 1.0 0.0 0.9 5.0 0.0 4.6 3.3 0.7 3.0 2.0 0.7 1.9
30-34 7.3 0.9 6.6 11.0 0.0 10.3 3.0 0.0 2.7 1.0 1.7 1.1
35-39 9.1 0.0 8.3 7.2 2.6 6.9 4.5 1.7 4.2 1.4 1.0 1.4
40-44 8.2 0.6 7.5 7.5 3.4 7.3 2.4 2.8 2.5 1.8 3.1 1.9
45-49 30.2 4.5 28.2 3.1 3.6 3.2 10.7 4.6 10.0 6.1 1.5 5.8
50-54 0.0 9.6 0.8 3.1 0.0 2.9 8.2 10.0 8.4 7.2 7.4 7.2
55-59 27.1 22.6 26.8 34.8 11.7 33.6 22.6 13.5 21.7 12.6 8.9 12.3
60-64 18.0 41.1 19.1 5.6 24.1 6.5 19.2 20.6 19.3 24.0 22.4 23.9
65-69 83.2 27.6 80.2 66.3 11.0 62.8 23.8 52.1 25.3 24.6 30.9 25.0
70+* 200.2 70.0 194.4 64.3 65.8 64.4 90.4 133.2 91.2 82.6 80.3 82.8
All 14.7 5.8 14.1 8.3 4.2 8.1 8.5 5.6 8.2 6.6 4.8 6.5
Source: Statistical Reports (1981 and 1999), Sample Registration System (SRS), Registrar General, India.
Note: * Indicates that the rate is estimated on the basis of rates for 70-74, 75-79, 80-84, and 85 plus age groups.
The situation in Himachal Pradesh, as regards the product (Directorate of Economics and Statistics), the
infant, child and under-five (U5) mortality, may compare living conditions of the population cannot be improved
favourably with the national scene, but the overall unless agriculture is given serious attention for
economic prosperity and social development of the state improvement in terms of productivity or creation of
is not reflected in its levels of infant and child survival alternate livelihood options.
(Table 5.7). In spite of the lower incidence of poverty, Recent estimates of IMR vary in Himachal Pradesh;
greater infrastructure facility in terms of irrigation, road NFHS measures infant mortality at 34 per 1000 live
density and market density, electrification of villages, births during 1994-98 while the SRS mortality rate is
types of communication, educational centres, medical 54 per 1000 births in 2001. Higher vulnerability of
centres and provision of drinking water (NIRD 1999), infants is visible from the data that the share of infant
lower share of casual labourers to all workers in rural deaths in total deaths was 18 per cent in Himachal
areas (NIRD 1999), rapid rise in agricultural wages for Pradesh, as against 4 per cent in Kerala (SRS 1999).
male workers (NIRD 1999), use of banking services at For a state known to have a good record in the
the household level, attainment of better living provision of social infrastructure and overall index of
standards and access to basic amenities in terms of human development, such a level of loss of life in the
housing, electricity, fuel for cooking, mobility, first year of birth is intriguing. Himachal Pradesh’s
communication (Census of India 2001), higher female record in bringing down child deaths is striking, and as
literacy, increasing private participation in health care in other states, IMR has declined here by little more
services and women’s exposure to mass media (NFHS than two-fifths since the early seventies, due to spread
2002), mortality has continued to be high for infants of health care infrastructure and services, rise in
and children in Himachal Pradesh. If development literacy and overall improvement in living standards of
means elimination of preventable deaths for human families. Yet, there have been periods when
welfare, then relatively higher mortality trends for achievements in controlling infant deaths have been
children below five years of age should cause rethinking patchy, as witnessed in 1974-78, 1983-88, and 1995-99.
on the nature of development in Himachal Pradesh. In tune with rest of India, mortality levels among
Since 71 per cent of the total population in the state is infants did not show signs of real decline and stagnated
dependent on subsistence agriculture, which in Himachal Pradesh in the nineties, as indicated by
contributes only 22 per cent to the net state domestic the time-trend (Table 5.8, Figure 5.4). Reasons for this
TABLE 5.7
Infant Mortality Rate (IMR) by Selected Background Characteristics in Selected States, India
State IMR 1 (2001) Percentage of Percentage of Percentage of Percentage of Percentage of Percentage of Annual Rate of Growth
Births in Medical Population Poor 3 Females Literate 4 Population Living Females Participating Households Using of SDP in per cent 8
Institutions 2 (2000) (2001) in Urban Areas 5 in Workforce 6 7
Electricity for Lighting (1991-92 to 1997-98)
(1998-99) (2001) (2001) (2001)
A.P. 66 49.8 15.8 51.2 27.1 34.9 67.2 5.0

Assam 74 17.6 36.1 56.0 12.7 20.8 24.9 —
Bihar 62 14.6 42.6 33.6 10.5 18.8 10.3 2.7
Gujarat 60 46.3 14.1 58.6 37.4 28.0 80.4 9.6
Haryana 66 22.4 8.7 56.3 29.0 27.3 82.9 5.0
H.P. 54 28.9 7.6 68.1 9.8 43.7 94.8 6.3$
J&K 48 35.6 3.5 41.8 24.9 22.0 80.6 —
Karnataka 58 51.1 20.0 57.5 34.0 31.9 78.5 5.3
Kerala 11 93.0 12.7 87.9 26.0 15.3 70.2 5.8
M.P. 86 20.1 37.4 50.3 26.7 33.1 70.2 6.2
Maharashtra 45 52.6 25.0 67.5 42.4 32.6 77.5 8.0
Orissa 91 22.6 47.2 51.0 15.0 24.6 26.9 3.3
Punjab 52 37.5 6.2 63.6 34.0 18.7 91.9 4.7
Rajasthan 80 21.5 15.3 44.3 23.4 33.5 54.7 6.5
Tamil Nadu 49 79.3 21.1 64.6 43.9 31.3 78.2 6.2
U.P. 83 15.5 31.2 43.0 20.8 16.3 31.9 3.6
W.B. 51 40.1 27.0 60.2 28.0 18.1 37.5 6.9
INDIA 66 33.6 26.1 54.2 27.8 25.7 55.8 6.9
Source: 1. SRS Bulletin, Registrar General, India, April 2003.

2. National Family Heath Survey 2 (1998-99), India.
3. Poverty Estimates for 1999-2000, Planning Commission, India.
4. 5. & 6. Provisional Population Totals, Papers 1, 2 and 3, Census of India 2001, Himachal Pradesh.
7. Series 1, Tables on Houses, Household Amenities and Assets, Census of India 2001, Himachal Pradesh.
8. Ahluwalia (2000).
$. Annual Plan (2001-2002), Planning Department, Government of Himachal Pradesh.
Note: 1. The estimates of poverty (percentage of population below poverty line) are based on a 30-day recall period and the states-specific poverty lines of
1999-2000.
2. ‘–’ Indicates data not available.
3. For Himachal Pradesh, the annual growth rate of SDP is based on the period 1992-97.
merit some investigation, in the context of the link Hence, for larger success in infant mortality
between overall economic growth in Himachal Pradesh reduction in Himachal Pradesh, there is a need to
and living standards of households (Table 5.7). accord greater priority to rural areas, where nine-tenths
The underbelly of infant mortality in many Indian of the total population reside. The major states (Kerala,
states has been the neonatal deaths. In Himachal Maharashtra, Tamil Nadu and West Bengal), with
Pradesh, these deaths constitute a whopping proportion mortality among infants before first birthday lower than
of total infant deaths, accounting for as high as 93 per in Himachal Pradesh, are those, which have been able
cent in 1999 (SRS). Unless neonatal deaths are to reduce infant mortality substantially by focusing on
significantly brought down, the scope for reducing rural areas consistently. The fact that rural areas in
infant mortality in the state is extremely limited. Himachal Pradesh require critical attention in this
Reducing neonatal deaths is extremely complicated, as regard is clear from the latest early-life mortality
it would presuppose wider changes in maternal well- statistics (SRS 1999). Neonatal and post-neonatal
being and creation of sophisticated infrastructure in infant mortality rates are shown as 39 per cent and 12
general, as well as in the existing hospitals to handle per cent higher respectively in villages than in cities
neonates for infections. Data show that infants have and towns. Lack of rural bias is one of the reasons for
greater probability of death in rural areas than in urban Himachal Pradesh having a much slower decline in
locations; share of infant deaths to total deaths being mortality during one and half decades of the last
much higher in villages (17.9%) than in towns and century, as indicated by the percentage change in the
cities (11.9%) in the state. IMR. Any innovative programme-formulation and
management must recognise this and factor-in this FIGURE 5.4

rural-urban dichotomy. Infant Mortality, India and Himachal Pradesh
(1971-73 to 1999-2001)
TABLE 5.8 150
Infant Mortality, India and Himachal Pradesh 125
Infant Mortality Rate

(1971-73 to 1999-2001)
100
Infant Mortality Rate
75
Year India Himachal Pradesh
Total Total Rural Urban 50
1971-1973 134 105 107 59 25

1972-1974 133 100 102 60
1973-1975 133 100 101 65 0
1971-73
1972-74
1973-75
1974-76
1975-77
1976-78
1977-79
1978-80
1979-81
1980-82
1981-83
1982-84
1983-85
1984-86
1985-87
1986-88
1987-89
1988-90
1989-91
1990-92
1991-93
1992-94
1993-95
1994-96
1995-97
1996-98
1997-99
1998-2000
1999-2001
1974-1976 132 114 116 60
1975-1977 133 114 116 55
1976-1978 129 110 112 57 Year
1977-1979 126 96 98 56
India (total) H.P. (total) H.P (rural) H.P. (urban)
1978-1980 120 92 93 59
1979-1981 115 82 83 60
1980-1982 110 75 77 56
1981-1983 107 73 74 52
intervention, the scope to reduce deaths during
1982-1984 105 79 81 45 childhood is enormous in Himachal Pradesh. The
1983-1985 102 85 87 42 deaths before fifth birthday (U5) in the state (42 per
1984-1986 99 87 90 40 1000 live births) is second lowest in the country after
1985-1987 96 85 87 39
1986-1988 94 83 85 42 Kerala (19), yet, far away from what can be done in
1987-1989 93 79 81 39 Indian situation, according to the recent NFHS.
1988-1990 88 75 77 38
1989-1991 84 73 75 37 Gender Bias in Infant and Child Mortality
1990-1992 80 70 72 37
1991-1993 78 68 70 35 Adjusting for data discrepancies, infant and
1992-1994 76 63 64 37
childhood mortality in Himachal Pradesh can be
1993-1995 74 61 63 39
1994-1996 72 61 62 39 associated with sex-differentials. SRS occasionally
1995-1997 72 63 64 38 establish that relatively higher female early-age
1996-1998 72 63 65 38 mortality in Himachal Pradesh is declining over time
1997-1999 71 63 64 38
1998-2000 70 62 64 38
(Figure 5.5). In view of considerable gains to both
1999-2001 68 59 60 36 sexes from the onset of mortality decline during last
three decades, such male-female divergence, as observed
(SRS), Registrar General, India. during late eighties, is possible when female children
benefit either equally or less in relation to their male
Mortality, at all stages of childhood, has declined counterparts. In spite of improvements in literacy,
considerably in most states including Himachal Pradesh expansions in outreach of health care services and
since the early eighties (Table 5.9). In India, the slowest advances in overall standards of living in recent times,
decline in child mortality was recorded in Himachal the sex composition of infant mortality trends in
between the early eighties and nineties. Kerala, Tamil Himachal Pradesh suggest that vulnerability of the girl
Nadu, and Gujarat have done well in all fronts of child is not a long-run issue. More recent data from
fighting early age mortality during these decades and NFHS between 1992-93 and 1998-99 indicate decline in
have been able to lessen substantially and uniformly the gender disparity in mortality that existed in
components of such mortality, namely, neonatal, post- Himachal Pradesh at every stage of childhood,
neonatal, infant, and child deaths. This needs to be particularly before the fifth birthday (Table 5.10).
emulated in Himachal Pradesh, which records a
Stillbirths
substantial loss of lives during childhood (0-4 years);
19 per cent of total deaths occur in childhood in The trend in the rate of stillbirths is a good
Himachal Pradesh as against five per cent in Kerala, 15 indicator of foetal health in particular and maternal as
per cent in Tamil Nadu and 17 per cent in Maharashtra well as child health in general. It also reflects
(SRS 1999). This indicates that with the right kind of complications during pregnancy caused by a variety of
TABLE 5.9
Mortality at Different Stages of Childhood, India and Major States
State Neonatal Mortality Rate Post-neonatal Mortality Rate Infant Mortality Rate Child Mortality
1981 1999 Per cent decline 1981 1999 Per cent decline 1981 2000 Per cent decline 1981 1999 Per cent decline
during 1981-99 during 1981-99 during 1981-2000 during 1981-99
A.P. 60 46 23.3 26 20 23.1 86 65 24.4 30 17 43.3

Assam 67 53 20.9 39 23 41.0 106 75 29.2 40 24 40.0
Bihar 74 41 44.6 44 22 50.0 118 62 47.5 43 21 51.2
Gujarat 75 43 42.7 41 20 51.2 116 62 46.6 41 20 51.2
Haryana 58 39 32.8 44 28 36.4 101 67 33.7 37 20 45.9
H.P. 15 50 -233.3 57 4 93.0 71 60 15.5 19 13 31.6
J&K 44 — — 28 — — 72 50 30.6 26 — —
Karnataka 49 43 12.2 21 15 28.6 69 57 17.4 24 15 37.5
Kerala 26 11 57.7 12 3 75.0 37 14 62.2 12 4 66.7
M.P. 81 61 24.7 62 28 54.8 142 87 38.0 61 30 50.8
Maharashtra 54 29 46.3 25 19 24.0 79 48 39.2 26 12 53.8
Orissa 80 61 23.8 55 36 34.5 135 95 28.9 42 27 35.7
Punjab 49 34 30.6 32 19 40.6 81 52 35.8 26 15 42.3
Rajasthan 60 50 16.7 49 31 36.7 108 79 26.9 50 25 50.0
Tamil Nadu 63 36 42.9 29 17 41.4 91 51 44.0 35 13 62.9
U.P. 96 52 45.8 54 32 40.7 150 83 44.7 60 28 53.3
West Bengal 64 31 51.6 27 21 22.2 91 51 44.0 34 14 58.8
INDIA 70 45 35.7 41 24 41.5 110 68 38.2 41 20 51.2
Source: Statistical Report (1981 and 1999) and SRS Bulletin, Vol. 36 (1), 2002, Sample Registration System (SRS), Registrar General, India.
TABLE 5.10
Neonatal, Post-neonatal, Infant, Child and Under-five Mortality Rate by Sex,
India and Himachal Pradesh (1992-93 to 1998-99)
Type of Mortality
Neonatal Post Neonatal Infant Mortality Child Mortality Under-five
Mortality Mortality Mortality
1992-93 1998-99 1992-93 1998-99 1992-93 1998-99 1992-93 1998-99 1992-93 1998-99
Himachal Pradesh
Male 41.6 27.9 25.6 16.9 67.2 44.8 17.6 9.0 83.6 53.4
Female 34.4 21.4 28.5 12.4 62.9 33.6 25.3 9.3 86.6 42.8
Female disadvantage(f/m) 0.8 0.8 1.1 0.7 0.9 0.8 1.4 1.0 1.0 0.8
India
Male 57.0 50.7 31.7 24.2 88.6 74.8 29.4 24.9 115.4 97.9
Female 48.1 44.6 35.8 26.6 83.9 71.1 42.0 36.7 122.4 105.2
Female disadvantage (f/m) 0.8 0.9 1.1 1.1 0.9 1.0 1.4 1.5 1.1 1.1
Source: National Family Health Survey (1992-93 and 1998-99), India.
factors, such as lack of proper nutrition, low level of The stillborn figures inherently reflect bias and are
maternal care, infections, delivery by unqualified not stable, as seen in Table 5.11. Yet, high rates of
personnel, and delayed referral, which aggravate the stillborns indicate poor quality of obstetric care and
problem. Stillbirth happens when a growing foetus health in Himachal Pradesh. Data on pregnancy-
suddenly dies either due to nutritional deprivation or outcome indicate greater incidence of stillbirths in the
owing to some defect with the placenta or the umbilical state (2.6%) as compared to the national average
cord that disrupts oxygen supply to the child. (2.0%). Stillbirths are unfortunate, and are regrettably
Stillbirths may also happen if the uterus starts overlooked by the policymakers and programme
contracting more than required but cannot push the implementers in the din and bustle of infant mortality.
foetus out due to its size or abnormal position, leading The surest ways to deal with the problem of stillbirths
to non-delivery. Trauma during pregnancy or delay in would demand covering smaller and remote localities
reaching the health centre can also cause stillbirth. with facility of antenatal care, safe delivery, faster
FIGURE 5.5 childhood, and reproductive life of females, unlike the

Female Disadvantage in Infant Mortality, India and major states in the country. This is a major constraint
Himachal Pradesh (1984-86 to 1998-2000) in health planning and performance.
1.4 Investigation of circumstances responsible for higher
levels of infant and child mortality in general, and
Female/Male IMR
1.2 excess female mortality in particular, leads to a set of

factors that are deeply embedded in the socio-economic
and living conditions of the households. For instance, a
1 study by Pandey et al. (1998) on Himachal Pradesh has
indicated that mother’s literacy, exposure to mass
0.8 media, access to flush or pit toilet, ownership of
1998-'2000
household goods, and standard of living and pattern of
1984-86
1985-87
1986-88
1987-89
1988-90
1989-91
1990-92
1991-93
1992-94
1993-95
1994-96
1995-97
1996-98
1997-99
differential care based on the sex of the child in
households, affect the chances of survival of the
Year
children below five years of age at various stages. When
India Himachal Pradesh controlled for the effects of other variables, the rural-
urban difference in child mortality disappears. Similarly,
Source: Statistical Reports (different volumes), Sample Registration System ,
Registrar General, India. caste- and tribe-status intrinsically enhances mortality
risks significantly. Overall poverty in the family is also
transport, as well as referral to emergency obstetric identified as a significant predictor of child mortality in
units, provision of blood transfusion services, the state. This often gets reflected in the maternal work-
promotion of iodised salt consumption, better status (Krishnaji 2002). Demographic determinants,
community awareness, etc. such as order of birth, sex of the child, mother’s age at
birth, length of the previous birth interval, etc., are
also found to be crucial in the prevalence of neonatal,
TABLE 5.11 post-neonatal, infant, child and under-five mortality
Incidence of Stillbirths, India and levels in the state (NFHS 1995 and NFHS 2002). In
Himachal Pradesh (1985-99) Himachal Pradesh, during the neonatal period, mortality
Year India Himachal Pradesh
is high for first order births and in the post-neonatal
Rural Urban Total Rural Urban Total
period for second and higher order births, indicating
the relative importance of biological and behaviourial
1985 10.8 8.9 10.4 6.1 2.5 5.9
factors. Longer birth interval (duration of previous birth
1989 13.1 11.2 12.7 10.0 5.2 10.6
1991 10.9 9.6 10.7 14.1 3.6 13.7
interval being at least 24 months and above) also
1994 7.3 15.2 8.9 6.2 11.4 6.5 significantly reduces mortality during neonatal, post-
1995 9.3 8.8 9.2 6.0 10.0 6.0 neonatal period and infancy by 36 per cent, 49 per cent
1996 9.0 9.0 9.0 6.0 8.0 7.0 and 43 per cent respectively. Likewise, the death of an
1997 8.6 9.0 8.7 6.0 9.0 6.0 older sibling at a comparatively young age also raises
1998 9.0 8.0 9.0 12.0 7.0 12.0
the post-neonatal mortality by 88 per cent. Antenatal
1999 11.0 8.0 10.0 14.0 18.0 14.0
visits also significantly reduce the neo-natal mortality
Source: Statistical Report (different volumes), Sample Registration System (by 43%) in Himachal Pradesh, as seen from the NFHS
analysis (Pandey et al. 1998). Research is required to
ascertain the role of a dominant backward population,
Causes of Death in Infancy and Childhood gender preference, access to and utilisation of health
care services particularly during natal and post-natal
Though reliable data on direct causes of death are
periods, slowing down of economic growth and the
vital for its assessment in early childhood, such
impact of the structural adjustment programme, on
information is rarely available in a format useful for
recent trends in infant and childhood mortality in the
initiating health-assessment and intervention
state.
programmes. The problem is much more compounded
for smaller states, for which the Survey of Causes of Further reduction in mortality, due to the above
Death in Rural Areas (Registrar General, India 1998) does causes, will certainly depend not only on the state of
not identify the top killer diseases during infancy, public health programmes in Himachal Pradesh, but also
on overall levels of economic and social development in These maternal deaths have strong implications for
terms of health, hygiene, environmental sanitation, levels infant survival, family ties and generational well-being,
of living, financial capacity to pay for health care and as they not only devastate the families concerned but
socio-cultural barriers in accessing it. The enormity of also create situations unfavourable to social and
the tasks ahead, in relation to infant mortality, can well economic harmony between generations.
be visualised from the fact that Himachal Pradesh has to Even if maternal deaths are substantial in India,
go a long way to achieve the national goal of bringing reliable data on these are yet to be available for the
down the IMR to 45 by 2007, 30 by 2010, and 28 by individual states. The SRS figures (1998) on maternal
2012, as laid down in the National Population Policy 2000 mortality are far from reality and elude the smaller
(NPP 2000) and the Tenth Five Year Plan (2002-2007). states including Himachal Pradesh, as do the available
This appears to be difficult to achieve as, for some time indirect estimates. The available data put the figures in
in the recent past, the infant mortality level has been Himachal Pradesh at a higher level, with 408 per
stagnating in the state, with the rates hovering around 1,00,000 live births in 1992 (Himachal Health Vision
60 per 1000 and not falling in tandem with economic 2020). Lack of studies on different dimensions of
and social development, as normally expected. maternal mortality, particularly in Himachal Pradesh,
Ways to fight infant mortality would include hamper efforts to address the problem. However,
removal of gender bias, strengthening of the Child existing evidence suggests that the state is still far
Survival and Safe Motherhood (CSSM) Programmes from the National Socio-Demographic Goal for 2010,
under the RCH umbrella, introduction of nutritional which aims to bring the MMR below 100 deaths per
programmes especially for anaemic mothers, proper 1,00,000 live births, as enunciated in the National
immunisation, baby-friendly infant-feeding practices and Population Policy 2000 (NPP 2000).
nourishment for the newborn, screening mothers-to-be Variations in maternal mortality can be directly
for antenatal check-up and nutritional intake, reduction related to rural and urban residence, availability and use
in the share of non-institutional births, adequate of health infrastructure for antenatal, natal and post-
provision for emergency obstetrics services, natal requirement, conditions of hygiene and birth-
strengthening the sub-centres, subsidiary health centres assistance for home deliveries, health awareness and
and primary health centres, and making women doctors overall levels of living, according to some hospital- and
widely available for female clients, particularly in remote community-based studies. Direct and indirect causes of
rural areas, and wider community involvement. maternal deaths have to be widely assessed in Himachal
Pradesh, for maternal death reduction programmes.
Maternal Mortality While the broad direct causes usually consist of
Childbearing being central to womanhood, the state haemorrhage, oedema, proteinuria and hypertensive
of maternal mortality shows how effectively women disorders, obstructed labour due to malposition and mal-
benefit from development in education, health, presentation of foetus, and complications predominantly
nutrition and medical care. Safe motherhood is high on related to puerperium, the indirect causes range from
the national agenda and maternal deaths are viewed tuberculosis, viral hepatitis, malaria and anaemia.
seriously. The successive plans in India, starting from As one of the priority areas, the WHO has
the First Five Year Plan (1951-56) to the Tenth Five recommended measures for promoting policy action,
Year Plan (2002-2007) recognise maternal mortality as society and community intervention along with health
an important indicator of socio-economic development, sector activation, to reduce maternal mortality. In the
women’s empowerment and access to basic health care context of Himachal Pradesh, this would mean
in the society (Planning Commission 1952, 2001). The increasing access of women to health-care centres
National Population Policy 2000 (NPP 2000) and the particularly during odd hours, eliminating unsafe
National Health Policy 2002 (NHP 2002) also reinforce practices during delivery and sensitising the community
this concern to policy priorities and aim to reduce the on its importance, regularly training and equipping
existing levels of maternal mortality to 100 maternal female health workers including dais, and making the
deaths per 1,00,000 live births by the year 2010. In community respond effectively to the needs of socially
India, despite policy statements, health planning and and economically backward pregnant women.
medical advancement, more than 1,00,000 women die Revitalising primary and subsidiary health centres and
every year from causes connected with pregnancy, the designation of certain health centres as nodal units
childbirth and related complications (NFHS 2000). depending on their respective infrastructure, habitation,
connectivity and availability of health staff, can be of decisive impact on future mortality regimes. Some basic
immense help. reflections on the causes of death are essential in this
context. Unfortunately, no reliable and disaggregated
Recent initiative of the Government of India in
statistics are available about these on a wider scale.
declaring 11 April as Rashtriya Janani Suraksha Diwas and
launching a new beneficiary-friendly scheme for poor The timing of infant death has also far-reaching
women to encourage deliveries in hospitals and health importance for framing measures that enhance the
centres and supporting nutritional food intake of chances of survival of the newborns. Since biological
pregnant women is regarded as a step forward. Since factors are largely decisive in determining chances of
most of the maternal deaths are preventable, the state survival in the neonatal period, and environmental and
government can achieve good results by implementing behavioural factors in the post-neonatal period,
schemes which ensure at least three antenatal check-ups interventions must recognise this classification. Since
at a health facility, one extra meal a day, iron and folic infant deaths are out of proportion according to the
acid supplementation for 100 days, delivery in a health ‘two-thirds rule’, deaths occurring in first 24 hours of
facility, recognition of danger signs of complicated life, then in the first week of life, and subsequently in
pregnancies and rush them to the nearest health centre, the first month of life, need to be tracked down for
and finally three check-ups after the delivery. remedial measures. As deaths in the first four weeks of
In addition to putting in place an effective life are determined by sets of proximate determinants,
demographic surveillance system, which includes namely maternal factors, environmental contamination,
registration and monitoring of pregnancies by local nutritional deficiency, injury, and personal illness
paramedics, measures to meet emergency situations with control (James et al. 2000), reduction in infant mortality
regard to childbirth and pregnancy complications can by bringing down neonatal deaths will significantly
also be helpful. One of the various ways of improving depend on substantial progress in containing these risk
assessment of maternal mortality is to upgrade the data factors. For instance, nutritionists argue that removal
on such deaths through advances in vital registration of iodine deficiency during pregnancy, which retards the
system, reporting of the exact cause of death, and growth and development of the foetus, will result in a
inclusion of some basic background characteristics. substantial reduction in stillbirths and neonatal
mortality (Dodd and Madan 1993). The nutritional
Prospects for Further Decline rehabilitation of expectant women also reduces the
Prospects for further drop in mortality is high in chances of birth of low birth-weight babies, who are
Himachal Pradesh. Reducing under-five mortality, more susceptible to death in neonatal period. But, the
which has been inordinately high at different stages, scope for nutritional improvement depends very much on
can ensure a decline in overall mortality; focus on the the extent to which the economic standards of living of
survival of female children can also tremendously the families are upgraded and opportunities for livelihood
contribute to reduction in overall mortality rates. are provided. Since premature births, another source of
high neonatal death, are difficult to avoid because of
Similarly, maternal mortality is another area where
inability to control infections and birth asphyxia
substantial reductions can be attempted to create a dent
without proper and equipped neonatal centres in the
in the general mortality level. Tracking down and
existing hospitals, the best way in the short run will
supporting groups, who, in a given situation, are more
be to stick to nutritional programmes. For this,
vulnerable to infant, child and maternal mortality, can
Himachal Pradesh has to place nutrition high on the
yield direct results. Rural crude death rate in Himachal
development agenda, as already done in Tamil Nadu in
Pradesh being close to the rural CDR in Kerala, the
the south.
state with the lowest mortality in India, the best way
will be to concentrate on infants and children in rural
Contraceptive Use
areas so as to get quick results. As one among select
states in India poised for demographic ageing, rise in The First Five Year Plan in India laid the foundation
the proportion of the elderly in Himachal Pradesh is of a state-sponsored family planning programme to
likely to inflate the total mortality level as, with rising reduce the growth of population, so as to stabilize it at
age (from 60 years onwards), the death-rate starts a level consistent with the requirements of the national
rising progressively. Moreover, development-linked economy (Planning Commission 1952). Since then,
epidemiological transition, lifestyles and medical and successive Five Year Plans have been providing funding
non-medical intervention programmes are likely to have a assistance to upgrade the infrastructures and to
improve quality, coverage and efficiency of family welfare south, besides Punjab in its neighbourhood. Since the
programmes all over the country. The Tenth Five Year inception of the programme, the contraceptive
Plan, like the previous ones, also makes an unequivocal prevalence rate (CPR) has consistently remained high in
commitment to free essential family welfare services. It Himachal Pradesh, as compared to the national average,
also highlights the need to make a dent on the fertility notwithstanding the controversies that had dogged the
profile of the country, through the removal of unmet programme during the ‘national emergency’ and due to
needs of contraception (Planning Commission 2003). institution of incentives. Apart from couples’ awareness
Notwithstanding policy rigidities, socio-cultural about method-use and availability, the phenomenal
barriers, programme deficiencies, etc., contraception growth in CPR can be attributed to vigorous
today is at the core of demographic changes that are programme implementation strategies, active involvement
widely sought, both officially and privately. of the government health sector, centring on ‘target’
fixation and achievement mainly tagged to incentives
Levels and Trends in Use and disincentives to programme-staff and clients. Both
In the past more than 55 years, the use of modern official service statistics and independent contraceptive
contraceptives in Himachal Pradesh has reached a prevalence surveys have consistently established the
significant proportion from virtually nil at the time of edge of Himachal Pradesh over others in making
independence. It is a leader in northwestern India in contraception reach the eligible population widely
family planning practice. The state is widely recognised (Table 5.12, Figure 5.6). In addition to a real difference
for its good performance in family planning programme, in use of methods, the differences between official and
like Maharashtra and Gujarat in the west, Andhra non-official figures can also be attributed to
Pradesh, Karnataka, Kerala, and Tamil Nadu in the methodological differences in the estimation.
TABLE 5.12
Current Contraceptive Prevalence Rate (CPR) due to All Modern Methods, India and Himachal Pradesh (1973-99)
Year All NFHS 2 Levels and Trends in Method Composition1

Methods1 Sterilisation IUD Condom Oral Pill
India H.P. India H.P. India H.P. India H.P. India H.P. India H.P.
1973 15.0 8.2 12.2 — 11.3 5.9 1.4 1.8 2.3* 0.5 — —
1975 16.3 9.5 — — 12.4 7.6 1.4 1.4 2.5* 0.5 — —
1976 18.9 13.5 — — 14.1 9.5 1.5 1.5 3.4* 2.4* — —
1977 26.1 32.8 — — 21.1 24.9 1.6 2.3 3.5* 5.6* — —
1978 24.4 27.1 — — 20.4 22.2 0.9 1.4 3.0* 3.5* — —
1979 24.4 24.8 — — 20.2 21.8 1.0 1.4 3.3* 1.6* — —
1980 23.9 24.5 — — 20.2 21.7 1.1 1.6 2.7* 1.2* — —
1981 24.3 26.1 — — 20.0 22.1 1.1 1.7 3.2* 2.2* — —
1982 25.6 27.0 — — 20.7 23.3 1.2 1.9 3.8* 1.8* — —
1983 28.4 29.6 — — 22.0 25.5 1.4 2.1 4.9* 2.0* — —
1984 32.4 32.4 — — 23.7 27.7 2.3 2.6 6.2* 2.1* — —
1985 35.8 36.1 — — 25.0 29.1 3.0 3.6 7.8* 3.4* — —
1986 38.7 42.6 — — 26.5 32.0 3.9 5.0 8.3* 5.6* —
1987 46.7 45.9 — — 27.9 33.5 4.8 6.2 7.4 5.1 1.3 1.1
1988 44.2 47.5 39.9 — 28.9 34.5 5.5 6.9 8.3 5.2 1.5 0.9
1989 46.7 51.7 — — 29.8 35.8 6.2 7.7 8.9 7.0 1.7 1.1
1990 48.6 54.6 — — 30.1 36.8 6.6 8.4 10.0 8.2 1.9 1.2
1991 49.6 56.9 — — 30.3 37.5 7.0 9.1 10.1 8.7 2.1 1.5
1992 48.6 58.8 36.3 54.4 30.3 38.6 6.6 10.0 9.4 8.4 2.2 1.7
1993 48.7 60.3 — — 30.3 38.7 6.6 10.8 9.9 9.0 2.0 1.7
1994 51.3 61.5 — — 30.3 39.6 7.2 10.7 11.2 9.1 2.7 2.2
1995 51.6 57.9 — — 30.2 40.5 7.6 10.3 10.8 4.8 3.0 2.4
1996 52.2 62.1 — — 30.2 40.7 8.2 10.7 10.7 8.2 3.2 2.5
1997 51.0 59.3 — — 29.6 40.3 7.8 9.8 10.4 7.0 3.1 2.3
1998 50.8 53.8 — — 29.3 36.9 7.6 8.6 10.1 6.1 3.8 2.2
1999 — 42.8 60.8 — — — —
Source: 1. Ministry of Health and Family Welfare (MoHFW), Government of India, Year Books (different volumes).
2. National Family Health Survey (NFHS), India, 1992-93 and 1998-99.
Note: 1. ‘*’ includes use of oral pills also 2. ‘—’ Indicates data not available 3. Figures are in percentages
FIGURE 5.6
TABLE 5.13
Couple Protection Rate, India and
Himachal Pradesh (1973-1998) Time Lag in Contraception, Himachal Pradesh (1999-2000)
80 Age/Time Lag (in years) Type of Contraceptive

Method
Couple Protection Rate
60 IUD Vasectomy Tubectomy
Mean age (of wife) at acceptance 1 27.5 29.7 28.1

40 Female mean age at first marriage2 18.6 18.6 18.6
Time lag in contraception 8.9 11.1 9.5
20
Source: 1. Directorate of Health and Family Welfare, Himachal Pradesh.
2. Multiple Indicator Survey (MICS), UNICEF 2000.
0
1973
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
children; 23 per cent of couples currently use any
Year modern method after one child as against 65 per cent
India Himachal Pradesh after two children and 80 per cent after three children.
Among one-child families, 27 per cent go for family
Source: Year Books (different issues) Ministry of Health and Family
Welfare, Government of India.
planning just after having a son as against 18 per cent
just after a daughter. Similarly, among two-child
Age Pattern of Use families, 80 per cent of currently married women resort
to family planning after two sons as opposed to 31 per
The age pattern of contraception in Himachal
cent after two daughters. A strong correlation also
Pradesh (Figure 5.7) is interesting. According to NFHS,
exists between the sex composition of the surviving
among the currently married women, in 1998-99, the
children and methods preference. Comparison between
use peaked in the ages 35-39 followed by 30-34 with 67
spacing and terminal methods shows that the
per cent and 69 per cent respectively using some
acceptance of terminal methods is largely dependent on
modern method of family planning. The younger age
the needed number of male children in the family. Even
couples (aged 20-24 years) report low use, the rate
such methods as condom and IUD, which do not give
being 27 per cent. Contraception among younger
finality to termination of child-bearing, are used by
women is more popular in urban than in rural areas.
couples after meeting the targets of family-composition
Official statistics on contraception in Himachal Pradesh
and size in terms of the required number of sons. If the
show that the mean age at acceptance has risen by one
family planning programme in the state has to make
year between 1986-87 and 1999-2000 for the acceptors
further inroads and be sustainable, it must address the
of IUD, and declined by one year for the acceptors of
gender dimensions confronting it.
tubectomy, and remained nearly stagnant for the wives
of vasectomy acceptors. These are not healthy
FIGURE 5.7
demographic signs. When linked to the age pattern of
fertility, it is observed that women basically resort to Age-specific Fertility Rate and Age-specific Couple
Protection Rate, Himachal Pradesh (1999)
contraception on a wider scale after their own
contribution to fertility at ages 20-24 and 25-29. If 0.25
contraception is to have a higher impact on fertility,
0.2
then ways must be found to make it more popular
Fertility/CPR
among younger women, and make spacing methods, 0.15

other than the IUD, more accessible during the time
0.1
lag between marriage and acceptance of a terminal
method (Table 5.13). 0.05
Son-preference influences family planning acceptance 0

in Himachal Pradesh. Whether the couples will opt for 15-19 20-24 25-29 30-34 35-39 40-44 45-49
contraception or not depends to a large extent not only Age group (in completed years)
on the total number of living children they have but CPR Fertility
also on the number of living son(s). According to
NFHS, family planning is mostly accepted after two Source: National Family Health Survey.
In Himachal Pradesh, the ‘Two Child Norm’ is contrast the Indian sex-ratio (defined as number of
strongly rooted in the fertility planning of the couples females per 1,000 males) has been consistently low for
and determines the choice of method. The idea that a long time. In the northwestern region, namely
contraceptives are only meant for use after the birth of at Himachal Pradesh, Uttaranchal, Punjab, Chandigarh,
least one child is highly ingrained in the minds of the Haryana, Delhi, Rajasthan, Gujarat and Maharashtra,
couples and needs to be changed. It also confirms that low sex ratio continues to be a demographic enigma
there exists vast scope in the state for expanding family and cause for concern. In Himachal Pradesh, the recent
planning practices among couples. At least, spacing census shows declining sex ratios for total as well as
methods, such as the IUD and condom, can be more the child population (0-6 age group) unlike the earlier
vigorously promoted in the state, particularly among ones since 1901, which had been consistently
women with no child, one child and two children. If indicating a rise in the sex-ratio for the total
specific concerns relating to pills are dealt with properly, population, except for a break in 1941. During 1991-
it could also be reasonably promoted among women. 2001, while a moderate increase in the femininity of the
total population, simultaneously with rising
Prospects for Future masculinity of the child population, was the situation
The family planning programme in Himachal Pradesh in India, in Himachal Pradesh it was increasing
like everywhere else has a dual responsibility. Besides masculinity for both the groups. In the northwest, the
making couples empowered in the process of numerical shortfall of females is intense in Punjab and
childbearing through reproductive choices, the its neighbourhood, both in child (0-6 years) and non-
programme has also to help in the attainment of child populations (seven years and above).
replacement level of fertility through universal access to Himachal Pradesh is noticeable in the northwest for
quality contraceptives and prevention of unwanted greater masculinity of the child population as compared
pregnancies. This would presuppose creation and to the national average (Table 5.14). Examination of
addition of proper infrastructure at the village level sex-ratio trends indicates that throughout the
given the fact that 90 per cent of the population in the twentieth century, Himachal Pradesh experienced a
state resides in villages, that are generally scattered and deficit of females and the problem of a sex-ratio
remote. Upgradation of existing hospitals, PHCs and imbalance is not a recent one. The concern is that
sub-centres, training of personnel and uninterrupted instead of getting corrected with time, the situation is
supply of contraceptives, tubal rings, laproscopes, deteriorating, as evident in the 1980s and 1990s.
vaccines and RCH drugs, etc., need to be undertaken
The dynamics of sex ratio are complex and broadly
widely. Active involvement of the non-governmental
explained in terms of variations in sex composition of
sector is essential and social marketing of
births, sex differences in mortality, sex discrepancies in
contraceptives also needs to be extensively promoted.
enumeration and the sex pattern of net migration.
At another level, family planning cannot be boosted Being proximate, these factors are responses to some
unless child mortality is brought down and couples are ultimate social, economic, cultural and technological
reassured about the survival of their children. Ante- changes in the society. In the absence of more recent
natal, natal and post-natal services have to be data on sex-specific coverage in the census, migration
streamlined and home deliveries, already high, have to trends for both the sexes in the inter-censal period, and
be drastically reduced. Better birth attendance and detailed age and sex composition of the population, it
nursing care will promote, in the absence of target is difficult to attribute the part played by each of the
setting, provider-client relationship to the advantage of above factors. However, the emerging pattern of sex-
family planning. This is exclusively in the hands of ratio imbalances in Himachal Pradesh can be
government health workers. Covering the inter-district comprehended to a large extent by concentrating on
disparity in determinants of family planning acceptance trends in the child sex ratio.
will also deliver good result in future.
Masculinity in child sex-ratio has been observed in
Himachal Pradesh since its statehood and male-female
Sex Ratios, Sex Preference,
imbalance continuously sliding since 1971 from which
and Sex Selective Abortions
year direct data are available on child sex composition.
The sex composition of the population is an However, the situation seems to have worsened faster
important indicator of social development. In most after 1981, with the femininity level in child population
populations, females exceed males numerically but, in dropping to 897 females per 1,000 males for the state in
2001. Census-based sex ratio indicates substantial rise 2001), even if the census-recorded sex ratios often
in the already masculine child population between 1981 under-report females (Natarajan 1972, Premi 1991),
and 2001 (Table 5.14). The origin of the current specifically in early age. This leaves the sex ratio at birth
imbalance seems to have been in the late eighties and (SRB) and excess female childhood mortality as the two
the early nineties with deficits culminating in 2001. main factors influencing child sex ratio in the state,
This can be directly related to the emergence and their relative contribution varying from one place to the
popularity of sex-determination tests in North India in other depending on the local situation. In addition to
general, and Punjab and its adjoining areas in the sex ratio at birth, the other distortion in child sex
particular, which receive large and regular inflow from ratio comes from excess female child mortality discussed
Himachal Pradesh in search of livelihood. earlier. Shortages of females, at birth and at early age,
create numerical disparity in the childhood for each
cohort, difficult to alter subsequently. Young-age
TABLE 5.14
children from both the sexes have gained in chances of
Changes in Sex Ratio, India and survival in Himachal Pradesh, especially during past two
Himachal Pradesh (1971-2001)
decades. Improvements in mortality conditions have been
Year India Himachal Pradesh able to wipe out, to a large extent, the excess female
All ages Children (0-6) All ages Children (0-6) disadvantage that had existed in mortality for some
time. Hence, higher female mortality in the young age
1971 930 964 958 981
as a significant determinant of sex ratio among children
1981 934 962 973 971
1991 927 945 976 951 (0-6 years) in the state seems to be less than expected.
2001 933 927 970 897
Sex Ratio at Birth
Source: 1. Provisional Population Totals, Paper 1 of 2001, Census of India 2001,
India and Himachal Pradesh. Data on sex ratio at birth, from more than one
2. Social and Cultural Tables, Census of India, Himachal Pradesh, 1971 source, with all the shortcomings, indicate an overall
and 1981.
tilt in favour of males that is rising faster in the recent
period in Himachal Pradesh (Table 5.15). In Himachal, a
There is no evidence of large-scale selective migration study recorded a SRB of 105, 107 and 117 during 15
in favour of male children in Himachal Pradesh, and the years period before 1984-98 (Retherford and Roy 2003).
gender difference in enumeration is also not considered It concluded that SRB gets further distorted in the
a significant explanation of child sex ratio imbalance absence of any living sons, which provides strong indirect
here, like elsewhere (Visaria 1971, Miller 1981, Krishnaji evidence of sex-selective abortions, after first births.
Data on annual births, culled from different registration
FIGURE 5.8
units, indicate state of affairs to be still more serious,
Changing Sex Ratio, India and Himachal Pradesh as the male births exceeded the female births
overwhelmingly in the state. Between 1996 and 2001,
1000
the number of male births per 100 female births,
hovering mostly around 115, indicate a substantial
960
surplus of male babies at birth. In spite of the
Sex Ratio
reservations one may have on the quality of such

920
registrations in a state that has 90 per cent of the
population living in villages, which are small, scattered
880
and remote, this is an indication of the extent of the
problem. Based on these indications, there is need to
840
reflect, in the first place, on as to why the sex ratio at
1971 1981 1991 2001
Year birth is so much biased in favour of males in Himachal
All ages (India) Children (India) Pradesh, and what are the reasons for it being
All ages (HP) Children (HP) increasingly so in the recent past?
In Himachal Pradesh, the male advantage is more
Source: 1. Provisional Population Totals, Paper 1 of 2001, Himachal Pradesh, Census of
India 2001, than ‘normal’ at the time of birth. This gives currency
2. Provisional Population Totals, Paper 1 of 2001, India, Census of India 2001. to the argument that a significant share of females are
3. Socio-cultural Tables, Himachal Pradesh, Census of India 1971, 1981 and
1991. lost either at the time of conception or during
TABLE 5.15
Sex Ratio at Birth, India and Himachal Pradesh (1978-2001)
State Sample Registration National Family Civil Registration System (CRS)

System (SRS) Health Survey (NFHS)
1981-90 1996-98 1978-92 1984-98 1996 1997 1998 1999 2000 2001
H.P. — — 107 108 114 116 118 115 117 117

India 110 111 106 108 — — — — —
Source: 1. Sample Registration System (SRS), Registrar General, India.

2. National Family Health Survey (NFHS) 1992-93: India and different states.
2. National Family Heath Survey (NFHS 2) 1998-99: India and different states.
3. CRS: Directorate of Health and Family Welfare, Government of Himachal Pradesh.
Note: 1. Sex Ratio at Birth (SRB) is defined as number of males per 100 females.
2. ‘—’ Indicates data not available.
pregnancy. Widely available sex-selection technologies, per cent at least a daughter, 26 per cent wanted more
at affordable prices, with little social or legal hurdles sons than daughters and 0.6 per cent more daughters
till recently, seem to have made intervention possible than the sons, highlights how the desire for a male
for couples, either at conception or during early child is entrenched in Himachal Pradesh.
pregnancy.
Sex-Selective Abortions
Sex Preference Theoretically, in the absence of significant disparity
Changes in juvenile (0-6) sex ratio can be linked to in net migration, age reporting, and gender differences
the overall preference for the male child in many areas in mortality for the males and females in the under-five
of Himachal Pradesh. Strong male dominance in age group, the strong desire for a male child makes the
property transfer, focus on male-centric rituals and sex ratio at birth increasingly masculine either through
kinship system, inadequate appreciation of women’s the adoption of ‘stopping rule’ or sex-selective
economic contribution, absence of strong social reform abortions. In Himachal Pradesh, it is likely that a
movements, etc., have contributed to higher value of sizeable share of female foetuses are terminated during
the male child among many communities in Himachali pregnancy. Data on the nature and scale of abortions in
society. In modern Himachal Pradesh, in spite of the the state do not indicate such a scale of pregnancy
rise in female education and legal support, there are terminations as to result in a highly masculine sex
many reasons, in popular perception, for not having a ratio at birth. Recent large-scale surveys do not
female child. Here, the position of the daughter-in-law establish a somewhat higher incidence of such
in the family is defined, on her arrival, to the culturally abortions in Himachal Pradesh than the national
sanctioned urgency of producing a child, preferably a average. Direct data too do not suggest acceleration in
son. induced abortions between 1992-93 and 1998-99 in
Himachal Pradesh (Table 5.16), in line with the expected
In spite of economic progress, institutional
impact of the proliferation of sex-determination clinics
arrangements, constitutional support and educational
and their users in the 1990s. Since most of the MTPs
campaigns, preference for a male child among the
are done in the private sector, the number of MTPs
couples still persists in Himachal Pradesh. As indicated
indicated by official statistics, fluctuating between the
in NFHS, the fall in mean ideal number of children
lowest of 4905 (in 1995-96) and the highest of 5938 (in
between 1992 and 1999 for ever-married couples in the
1996-97) during 1994-95 and 1999-2000 do not reflect
state from 2.4 (1.3 sons, 0.8 daughters and 0.3 children
the reality. Interestingly, much of these MTPs are
of either sex) to 2.2 (1.1 sons, 0.8 daughters and 0.3
attributed to failure of contraception by the couples.
children of either sex) can be associated with decline in
son preference. This welcome sign is mixed, as it also Notwithstanding the above statistics, most likely
comes with a virtual stagnation in the desire for underestimates, induced abortion is well accepted in
daughters among the couples during the same period. many parts of Himachal Pradesh, transcending
The fact that among ever-married women in 1999, 88 communities, castes and economic groups. A recent
per cent of the couples wanted at least a son and 79 survey in Bhawarna Block (Kangra) shows that among
238 currently married women, a total of 8.4 per cent below, following up of pregnant women while giving
had induced abortions (CRRID, 2000). Illiterate women antenatal care till the end of child bearing, etc. The
and women in socially backward communities, landless results of such exercises are yet to be assessed.
and poor households have been observed resorting to
voluntary termination of pregnancy in this survey. The Demographic Ageing
motives, methods and consequences of such sex- When a society, with a sizeable share of younger
selective abortions need to be examined in detail. The population, is transformed into another with a sizeable
popularity of sex determination tests is clear from the share of older population, the average age of the entire
fact that in Himachal Pradesh among mothers who population rises. In the absence of substantial in-
received antenatal check-ups, 15 per cent received migration of younger population, falling mortality and
ultrasound or amniocentesis three years before 1999 fertility inevitably lead to population ageing during the
(Arnold et al. 2002). course of demographic transition. In India, high fertility
has maintained, for long, youthfulness of the
TABLE 5.16 population. With the onset of fertility and adult
mortality decline, the percentage share of the aged, 60
Pregnancy Outcomes for Ever-married Women, India and
Himachal Pradesh (1992-93 to 1998-99) years and above, in the total population increased from
5.63 in 1961 to 6.70 in 1991 and to 7.90 in 1998-99.
Last Pregnancy Himachal India After Kerala (8.82%), Himachal Pradesh has a higher
after 1.1.95 Pradesh
share of the aged in its population (8.12%), followed by
Nature of Outcome H.P. India 1992 1998-99 1992 1998-99
Punjab (7.84%) among the major states in India
Spontaneous abortion 1.9 1.9 6.0 4.5 4.5 4.4 according to the 1991 Census. The most recent estimate
Induced abortion 0.7 1.1 1.3 1.6 1.3 1.7 from NFHS puts the proportion of population in the age
Still birth 1.3 0.8 2.7 2.6 2.3 2.0
group 60 and above in Himachal Pradesh at 10.0 per cent
Live birth 96.0 96.2 90.0 91.3 92.0 91.9
in 1998-99. Existing projections also indicate a
All 100.0 100.0 100.0 100.0 100.0 100.0
consistent and long-term rise in the proportion of elderly
Source: 1. National Family Health Survey (NFHS) 1992-93 and 1998-99: India population in most of the Indian States, including
and Himachal Pradesh.
Himachal Pradesh (RGI 1996). Notwithstanding the
2. Rapid Household Survey (RHS), Phase I, India, 1998.
low percentage of the elderly in India at present, the
issue of ageing assumes added significance due to their
Effects of sex imbalances are manifold in terms of
sheer numbers in absolute terms, greater incidence of
social, cultural and economic consequences. It is widely
poverty, wider vulnerability and lack of social security
believed that deficit of females lead to rise in spousal
in old age in a fast changing economic and social
age gap through ‘marriage squeeze’, replacements of
structure and extensive disparity among the regions.
intra-family female discrimination by inter-family female
discrimination, change in dynamics of household Expectation of Life
economy, besides crime against women and others. Sex
selection cannot be contained unless son preference is Improvements in living conditions and health have
continuously led to reduction in overall mortality levels
dismantled, unabated commercialisation of health
services are checked, the government health sector across sections of the society and this has led to, on an
improves services dramatically to offset attraction by the average, a longer life span for individuals in Himachal
Pradesh. The fact that mortality declines in the state
private sector, the Pre-natal Diagnostic Technique
(Regulation and Prevention of Misuse) Act, 1994 is have immensely contributed to population-ageing is clear
implemented and more couples are sensitised through from the data on rising expectation of life at birth and at
ages 60, 65 and 70 and above, between 1970-75 and
social movements. But the final blow to female foeticide
may come from the rejection of social practices like 1991-95 (Table 5.17). In the backdrop of national gains
dowry and true economic empowerment of females in in longevity for both sexes, increments in life expectancy
have been much higher in Himachal Pradesh.
society. The Government of Himachal Pradesh has
initiated some steps to counter the trend, which Females in the state benefited more than males from
include greater focus on districts bordering Punjab, the increase in life expectancy in tune with the
awareness campaigns, co-ordination with the national trend between 1970-75 and 1991-95. In
departments of Education, Social Welfare, and Panchayati approximately 21 years, increment in female life
Raj, motivation of heath workers at the district and expectancy has exceeded the increment in male life
expectancy at birth and at selected ages. Males and 1991 and seems to have touched 0.6 million mark at
females in Himachal Pradesh have had their longevity at the turn of the century, thus causing a gigantic 145
birth increased by 17 per cent and 27 per cent per cent rise in 30 years. The female aged population
respectively as against 12 per cent and 20 per cent multiplied by 2.68 times (from 0.105 million to 0.281
respectively, at the all-India level during this period, million) in three decades as opposed to 2.24 times rise
making gains of 9.3 and 13.8 years, respectively. (from 0.143 million to 0.321 million) in male elderly
numbers between 1971 and 2001.
TABLE 5.17
Life Expectancy at Selected Ages, India and TABLE 5.18
Himachal Pradesh (1970-75 to 1991-95) Share of Aged (60 and above) in Total Population, India
and Himachal Pradesh (1971 to 1998-99)
At age India Himachal Pradesh
(in years) Period Male Female Male Female Year India Himachal Pradesh
Rural Urban Total Rural Urban Total
0 (At birth) 1970-75 50.5 49.0 54.8 50.9
1976-80 52.5 52.1 58.1 54.9 1971 6.21 4.98 5.97 7.4 4.3 7.2
1981 6.84 5.36 6.49 7.7 5.1 7.5
1981-85 55.4 55.7 58.5 62.9
1991 7.11 5.75 6.70 8.4 5.4 8.1
1986-90 57.7 58.1 62.4 62.8
1998-99 * 8.10 7.30 7.90 10.0 8.4 10.0
1991-95 59.7 60.9 64.1 64.7
Increase* 9.2 11.9 9.3 13.8 Source: 1. Ageing Population of India: An Analysis of 1991 Census Data ,
Registrar General, India.
60 1970-75 13.4 14.3 15.1 13.1 2. * National Family Health Survey (1998-99).
1976-80 14.1 15.9 15.8 15.2
1981-85 14.6 16.4 15.1 18.2
In two decades since 1971, for which the census
1986-90 14.7 16.1 16.8 17.5
data on ageing is available directly, one gets some
1991-95 15.3 17.1 18.6 16.2
impression of how fast Himachal Pradesh is moving
Increase* 1.9 2.8 3.5 3.1
towards ‘demographic’ ageing. For each sex, males and
65 1970-75 10.9 11.6 12.9 10.1 females separately, the fact that average growth in the
1976-80 11.7 13.2 12.8 12.6 number of those aged 60 and above is higher than the
1981-85 12.0 13.6 11.8 14.8 average growth of population in all ages in respective
1986-90 11.9 12.9 13.9 14.0 categories, is a strong pointer to the foundations of
1991-95 12.5 13.9 15.9 12.5 ageing. Himachal Pradesh is not an isolated case as the
Increase* 1.6 2.3 3.0 2.4 scene here corresponds broadly with the national scene.
70+ 1970-75 8.6 9.2 9.6 7.6 The average annual growth rate among the elderly in
1976-80 9.6 10.9 10.5 10.4 Himachal Pradesh varied considerably by sex and age.
1981-85 9.7 11.0 9.3 12.8 Between 1971 and 1991, the population of elderly
1986-90 9.4 10.0 11.2 10.9 women rose from 0.10 to 0.20 million and that of
1991-95 10.0 11.0 13.3 9.4 elderly men from 0.14 to 0.22 million; the growth rate
Increase* 1.4 1.8 3.7 1.8 of the former exceeding the growth rate of the latter,
indicating a faster pace of ageing among the females as
Source: Ageing Population of India: An Analysis of 1991 Census Data, Registrar
General, India. against males in the state (Table 5.19). Among both
Note: * Increase between 1970-75 and 1991-95. male and female elderly population, growth rates of the
‘young-old’ population (aged 60-79) exceeded those of
With gains in the average life expectancy being the ‘old-old’ (aged 80 and above).
substantial in the state as observed, survival to a higher
Condition of the Aged
age is increasing, and causing a continuous rise in the
numbers and percentages of persons aged 60 and above Unfortunately, not much is known about the old-
in both rural and urban areas (Table 5.18). Rise in the age population in Himachal Pradesh, except their basic
share of male and female elderly in Himachal Pradesh, conditions of living. As the 1991 Census summarises,
when considered against the national context, is on the the elderly (aged 60 and more) in the state are primarily
higher side. The old age population in this tiny state rural based (94%), literate with education up to
increased from 0.25 million in 1971 to 0.42 million in primarily level (62%), source of substantial workforce
employment in non-agricultural activity and domestic

TABLE 5.19
chores are the commonly reported activities in old age by
Average Annual Growth Rate of Aged Population, males (24%) and females (51%) respectively. The
India and Himachal Pradesh (1971-91)
ownership of property and financial assets among the
Age (in Himachal Pradesh India elderly is higher for males than for females, though such
completed years) Male Female Male Female female-male disparity is lower in urban areas (0.951 and
0.821) than in rural areas (0.712 and 0.777) of the state.
60+ 2.77 4.42 3.70 3.63
All ages 2.41 2.54 2.73 2.70
The same pattern is also observed with regard to
60-69 2.40 3.64 3.27 3.40 management of property and financial assets in the state.
70-79 3.24 6.04 4.12 3.97 In the social sphere, the elderly make significant
80-89 3.85 6.00 5.93 4.54 contribution. Irrespective of sex, they are overwhelmingly
90-99 3.20 5.01 5.39 4.16 involved in activities and participate fully in social and
100+ 1.04 0.22 1.25 0.47 religious matters and participate in the household
chores. The participation rates for aged persons being as
Source: Ageing Population of India: An Analysis of 1991 Census Data, Registrar
General, India. high as 85 per cent in social matters, 89 per cent in
Note: Figures are in per cent. religious matters, and 81 per cent in household chores
in rural areas, and 95 per cent, 98 per cent and 88 per
cent household respectively in urban areas.
(participation rates for total workers being 65 per cent
for males and 28 per cent for females) and are Morbidity figures indicate that during old age,
cultivators (85% of total male and 95% female workers women tend to report more ailments than men, and
in main category). those residing in towns and cities more than those
living in villages. Reported health problems are broadly
The 52nd round of survey of National Sample Survey similar between the sexes in old age. Men mostly report
(NSS) also brings out the socio-economic profile of the problem of joints, followed by cough, high/low blood
aged in Himachal Pradesh. With regard to marital pressure, urinary problem and heart disease, and women
status, the aged males are primarily currently married chiefly complain of problems in the joints, high/low
(79% in rural areas and 77% in urban areas) and aged blood pressure, cough and heart disease in Himachal
females are mostly widowed (64% in rural areas and Pradesh when they cross the age of 60. Besides these,
66% in urban areas). Living arrangements of the elderly old men mostly report visual, hearing and locomotor
vary on the basis of their sex rather on the basis of disabilities and old women visual, hearing, locomotor
place of residence. Less than one per cent of the elderly and amnesia or senility disabilities.
in the state live alone, either as an inmate of an old age
home or outside such a home. In rural areas, a majority Implications of Ageing
of aged males (63%) stay with spouse and other
Rise in the proportion of the elderly in the scale
members of family, as against aged females who stay
observed and expected in Himachal Pradesh, has
with children but without spouse (54%).
multifaceted consequences that need to be addressed
Data on the state of economic independence of the seriously. These broadly relate to continuing social,
aged indicate that the males (57% in rural areas and economic, cultural, technological and health
61% in urban areas) are financially independent for transformations in the society. Specifically, these
livelihood, unlike the females who were fully dependent implications can be elaborated as changes in marital
on others (49% each in rural and urban areas). Among status, newer living arrangements, widespread age and
those elderly who are fully dependent on others for gender discrimination, ongoing epidemiological
economic reasons, 43 per cent in rural areas and 49 per transition, frequent loneliness and depression,
cent in urban areas have to depend on more than one impairment of functional status leading to disability,
person to eke out a living, at times as many as nine. In lowering of socio-economic status, decline in family
old age, own children are the most reliable and support, non-availability of social security, lack of care-
important sources of financial support, both for males giving, vulnerability to natural disasters, restructuring
(87% in rural areas and 82% in urban areas) and females of economy, etc. One such implication in financial
(79% in rural areas and 64% in urban areas). Self- terms relates to the burden of pension and retirement
employed agriculture is the usual activity for the elderly benefits. The committed expenditure of the state on
(54% male and 36% female) in rural areas, whereas self- wages and pension and retirement benefits grew in
Himachal Pradesh from Rs. 118.4 crore in 1995-96 to While dealing with ageing in Himachal Pradesh,
494.9 crore in 2002-03 (Budget estimate). There is need lessons have to be drawn from other ageing societies,
for more research and documentation in these areas for so that the mistakes of treating the problem primarily
effective intervention. as an issue of health care and economic empowerment,
is repeated in policy planning for the elderly. In
Need for Suitable Measures addition to these two aspects, the social and emotional
At the national level, the National Policy on Older dimension of ageing must be addressed, if its onslaught
Persons (NPOP), announced in 1999, recommends a is to be effectively dealt with. For a regime of
series of steps that help to deal with issues related to ‘productive ageing’, foundations for a new philosophy
ageing. Similarly, the Action Plan outlined in the of ageing is essential, where older persons are active
National Population Policy 2000 emphasises the need for contributors to society rather than mere consumers.
greater care for older persons. In Himachal Pradesh,
there is need to assess the progress that has been made Civil Registration
till date under NPOP and encourage continuing Civil Registration System (CRS) is a continuous,
support to the elderly at various levels. For instance, permanent and compulsory recording of occurrences and
the Social Old Age Pension Scheme (for social security characteristics of vital events (birth, death, marriage,
to helpless older persons aged 60 and above) and separation, pregnancy, etc.) as defined in and provided
National Old Age Pension Scheme (social security to through decree or regulation in accordance with the
persons above 65 years of age) are two direct legal requirements of the country. Registration of vital
interventions aimed at restoring the financial stability events in any population is of paramount importance
of individuals with an aid of Rs. 200 per month to for the individual and the state. With the state
deserving cases. Need for ‘Old Age Homes’ and ‘Day increasingly assuming a greater role in the life of an
Care Centres’ for the aged in Himachal Pradesh are also individual, the need for registration of such events is
to be assessed in the state. Besides these schemes, the progressively felt for legal, protective, administrative and
Department of Welfare for Social, Women and statistical uses. Admission to the school, exercise of
Scheduled Castes and Scheduled Tribes also has a voting rights, ownership and transfer of property,
number of other programmes in tandem that can insurance entitlements, social security benefit,
indirectly help the aged in the state. It is essential to employment provisions, emigration, foreign visits, etc.
take a fresh look at these programmes. are few of such uses. An efficient registration system is
For the welfare of individuals during their twilight an asset in micro-planning for the health sector,
days, some complementary measures are needed. These particularly in serving the underserved population
groups. For example, registration of pregnancies and
include motivation of individuals to make provision for
their own as well as their spouse’s old age, and other births can boost the immunisation impact. In view of
old family members; ensuring primacy of non- this, the National Population Policy 2000 stresses the need
institutional care; added protection for vulnerable to achieve 100 per cent registration of births, deaths,
elderly such as widows, frail, handicapped, abused and marriages and pregnancies in the country by 2010.
destitute; promotion of geriatric health care and Registration of Births and Deaths Act 1969, which
services, monitoring, evaluation and upgradation of enables the Central Government to regulate registration
services for the elderly; fostering inter-sectoral and compilation of vital statistics in the country so as
partnership and spread of awareness for the elderly. to ensure uniformity and comparability, leaving enough
Involvement of the district administration, local self- scope to the states to develop efficient system of
government, NGOs and Panchayati Raj institutions and registration suited to regional conditions and events,
self-help groups in devising integrated programmes, was implemented in the state on 1 st April 1978.
also need to be initiated and examined. The actions for Himachal Pradesh Births and Deaths Registration Rules
a regime of productive ageing must move beyond 2003 also extend the provisions of this Act. Currently,
progress in the establishment of old age homes to a the births and deaths occurring anywhere in the state
broad system of social security, which incorporate are required to be registered within 21 days of the
equity concerns for caste, gender, resources and other events taking place at the usual residence. If events are
disadvantages. Such an attempt will make the current not registered within this stipulated period, late
and future initiatives and measures more meaningful registration can be allowed with payment of a late fee
and relevant to the needs and welfare of the aged. and following a predefined procedure. Besides
registering births and deaths, information is also highest level in the state and leading public dignitaries,
collected on some key social and economic aspects in including the Chief Minister and other Ministers, often
the specified form. There are 3,037 rural and 57 urban appeal to the public on importance of registration.
registration units in the state. The Director of Health Regular orientation courses are also conducted for the
Services in the state is the Chief Registrar (Births and ‘Local Registrars‘ for training on the subject. A state-
Deaths). The Chief Medical Officer and District Health level ‘Coordination Committee’ under the chairmanship
Officer of the district are his subordinates as District of Secretary to Government (Health and Family Welfare)
Registrar (Births and Deaths) and Additional District is also constituted to look into the reported shortcomings
Registrar (Births and Deaths), respectively. of the CRS.
Himachal Pradesh has relatively a better civil In spite of the strides that Himachal Pradesh has
registration system as compared to other states in made in streamlining the CRS, there are some areas that
India. Considerable improvement in the CRS seems to need greater attention. For example, registration deaths
have been achieved during late 1990s in spite of the are lower than the registration of births. Particularly, the
constraints of remoteness of villages in the state. deaths during neonatal period are a matter of concern as
Though nearly 100 per cent registration of births is they are not registered. Such under-reporting of deaths
claimed in the state, some would urge independent
verification of reported efficiency (Table 5.20). Vital FIGURE 5.9
statistics, as recorded in the CRS, are regularly published CBR as Reported by CRS and SRS,
and available for the lower administrative units such as Himachal Pradesh (1991-2001)
the developmental blocks and Panchayats. This can largely

be attributed to initiatives that the state has adopted in 30
making registration ‘People centred’. Panchayats in the 25
rural areas are assigned the tasks of registration. Regular 20
CBR
campaigns are conducted all over the state to sensitise 15

the public on the importance of such registration and 10
educational materials are widely distributed to educate 5
the public. The campaigns launched by the Department 0
of Health and Family Welfare have the patronage at the
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
Year
TABLE 5.20
CRS SRS
Efficiency of the CRS, Himachal Pradesh (1991-2001)
Year CBR CDR Level of Efficiency

of the CRS FIGURE 5.10
CRS SRS CRS SRS CBR CDR CDR as Reported by CRS and SRS,
Himachal Pradesh (1991-2001)
1991 13.2 28.5 2.9 8.9 47.1 33.3
1992 14.7 28.1 3.3 8.8 52.8 37.4
1993 13.8 26.7 3.3 8.6 51.3 37.8 10
1994 15.1 26.3 3.7 8.6 57.9 42.5 8
1995 17.6 25.2 4.2 8.7 70.8 49.6
6
CDR
1996 19.6 23.0 4.9 8.0 85.4 61.0

4
1997 20.2 22.6 5.0 8.1 89.3 61.8
1998 19.8 22.6 5.1 7.7 87.7 66.3 2
1999 20.4 23.8 5.3 7.3 86.6 72.7 0
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2000 22.9 22.1 5.4 7.2 94.7 74.8

2001 21.8 21.2 5.7 7.1 98.9 79.4
Year
Source: 1. Civil Registration System (CRS), Annual Report 2002 , Chief
Registrar of Births and Deaths and Director of Heath
Services, Himachal Pradesh. CRS SRS
2. Statistical Report (different issues) and SRS Bulletin, April
2003, Registrar General, India. Source: Civil Registration System (CRS), Annual Report 2002, Chief Registrar of
Births and Deaths and Director of Heath Services, Himachal
Pradesh.
needs to be corrected by policy measures, and if need be translating them into reality is difficult and time-
through local and temporary incentives. Regional enduring. This is why demographic programmes have
variations in the registration of demographic events also long gestation periods before yielding results. Anchored
merits extra inputs and the districts and blocks strongly in the economic and social conditions of the
consistently showing relatively poor performance be people, the fate of human resources in the state is
closely monitored. Awareness needs to be increased for going to be tied to progress in other areas. Bringing
registering the marriages. Though in villages and towns about desired behaviourial changes in the target
the marriages are registered with the same authority as population and influencing demographic development is
births and deaths, yet the marriage statistics are complex and profoundly influenced by the strategies of
forwarded to the Department of Social Welfare and not economic development and overall improvement in
to the Department of Health and Family Welfare. Not living standards. Moreover, unlike other areas, the
much is known about the marriage registration, as the externalities are crucial to demographic attainments and
data on marriage statistics are neither readily available there is a great deal of interdependence between
nor published by the Department of Social Welfare. Some population dynamics in the state and events outside,
argue that marriages are widely registered because of the in-migration being a case in point.
need to obtain the ration cards, while many attribute The contours of population planning in Himachal
poor registration of marriages to selective necessity, Pradesh must go beyond the elementary goals set in the
namely the emigration or marriage against the wishes of National Population Policy or outlined in Health Vision
parents. More training and monitoring camps need to be 2020. Demographic priorities need to go beyond the
organised in far-off areas. Uninterrupted supply of forms domain of health and cover grounds that are central to
and other stationeries to local units required for record larger issues of human development. Some of the direct
keeping also need to be addressed. There is a need to and foreseeable demographic challenges that Himachal
educate the migrant groups more. Moreover, greater faces today can be listed as attainment of replacement
functional coordination between the Joint Registrar level of fertility, elimination of early-age marriage and
General, local representative of Registrar General, India child-bearing, investment in health care of the new-
and Chief Registrar (Births and Deaths) is desired for born through low cost ventures to further reduce infant
meaningfully training the concerned staff and collecting, mortality including neonatal deaths, getting rid of sex-
utilising and disseminating the data on vital statistics. selection and practice of female foeticide, balancing a
This is more relevant in the context of long-term goal of skewed sex ratio that is highly masculine among
replacing the Sample Registration System (SRS) with the children, eliminating extensive son-preference, raising
Civil Registration System (CRS). Involvement of the data low hospital delivery rates, curtailing the birth of low-
users at some stage may also add to the benefits of weight babies, bringing down undesirable maternal
gathering information on births and deaths. There needs deaths, changing the unfavourable demographic regime
to be micro-filming of old records for preservation or among socially and economically weaker sections,
computer storage of early registration figures in those mainstreaming the marginal migrants groups, meeting
units, which have data before and immediately after the unmet need for contraception, promoting men’s
independence for protection for better understanding of participation in family planning, removal of
historical demography in the state. Measures to protect demographic disparity among the districts and
such historical data from hazards like fire, etc, are also preparations for dealing with an ageing population. In
recommended. an ecologically-sensitive state like Himachal Pradesh,
population and development linkages envelop
Demographic Challenges and Opportunities: environmental concerns that need to be addressed
Perspectives For Future satisfactorily. At one level, these thematic areas must
Himachal Pradesh has done exceedingly well in be at the core of a series of actions by the state,
expanding basic amenities and infrastructure. Attempts whereas at the other, some critical areas should be
at further economic and social development must also simultaneously considered to make the thematic
include focus on demographic dynamics. The outcomes successful.
demographic challenges the state faces today are Increasing private sector participation to
manifold and steps are needed to address these supplement government’s effort in the health sector is
concerns. Demographic goals may be easily articulated, a daunting task in view of low levels of urbanisation
quantified and enunciated in policy documents, but and extensive spread of rural population over 20,000
villages in a difficult terrain. This also has registration system at the village level, side by side with
implications for the achievement of demographic goals overhauling present data collection, compilation,
in the state. In rural areas, General Hospitals, Civil management and use-systems, are called for, as the
Dispensaries, Community Health Centres, Primary current information management system is unable to
Health Centres, and Sub-Centres are not fully keep pace with the rapid and ongoing changes in the
equipped to respond to people’s needs, which are society. Useful data, thematically oriented and geared to
mounting due to better literacy and awareness. These shifting priorities, have to be regularly collected and
centres are known to have constraints that prevent whatever is collected has to be rigorously tested,
optimum utilisation of their services. Since family systematically compiled, and made accessible to the
planning is largely seen as a government’s initiative public through regular and priced publications. The
and implemented mainly through the health focus on segregation at various levels is lacking, with
department, public health sector performance is critical maintenance of records in most of the health
to the success of the family planning programme. institutions deficient and unreliable. Utility of data
Another area, which merits attention, is the need management is yet to be fully understood and the
meagre networking with nodal centres yields fewer
for greater public participation. Broad-basing
inputs to field staff. There is need to examine the
community participation implies not only greater
involvement in programme-implementation but in policy constraints and strong support to such endeavor, in
terms of allocation of funds, qualified personnel and
formulation as well. Often schemes fall short because
infrastructure.
they do not reflect the needs and concerns of the people
with changing times. With the 73rd and 74th Can the superiority of Himachal Pradesh in social
Constitutional Amendments providing a framework for development be retained for long, without taking a view
grassroots devolution and local participation, efforts to of economic costs of such development? Spending on
stabilise population can only succeed if the functions, social development programmes in the state, it is often
functionaries and funds are used in tune with argued, have added to its current financial problems.
expectations of the public at all levels. Related with this Since sufficient enterprise is not available locally in
is the identification of fringe and vulnerable groups and Himachal Pradesh, and outside entrepreneurship is very
ensuring that their legitimate interests are well nearly discouraged, the need is to augment the speed
represented in programme formulation and of, rather than turning, the demographic tide in
implementation. Scheduled Caste and Scheduled Tribe Himachal Pradesh. This is possible, with the current
population, migrant groups, landless households, etc., higher ranking in human development being its great
constitute such marginalised sections whose asset. Additionally, the state has some inherent healthy
demographic profiles may need more attention. Creating features that are the source of enormous advantage in
adequate opportunities for these groups, and population planning and weigh heavily in favour of
safeguarding their interests is another major task in the attempts to define and shape demographic attributes.
future for achieving demographic goals. The current Relatively small population, low incidence of poverty,
programme interventions do not address gender high accessibility and use of banking services, good
disparities adequately. Much of the success in population ownership of motor vehicles for mobility and telephones
and related programmes depends on how the issues that for outside communication, wider access to basic
confront women and children are reflected in the policy amenities in terms of provision of tap water, larger
and programme priorities. Since women are at the centre share of households living in permanent houses and
of demographic change, creating a mechanism that is lower share of one-room dwelling units, modernisation
sensitised towards their position in society, will also of households with electricity as the source of lighting
determine the success of initiatives by the government. and separate kitchens and LPG use, less rural-and-
Reliable, long-term and cross-sectional data, aid urban gap in the provision of health services,
demographic assessments and make policy formulations household prosperity, regular media exposure through
and programme interventions accurate as well as highly diffused television and radio possession, greater
focused. In Himachal, there is need to encourage female literacy and participation in labour-force, greater
indigenous data generation, particularly in the course of community participation in public life, better women
programme intervention in areas such as birth empowerment, etc., act as force-multipliers in
statistics, neonatal mortality, birth weights, intervention activities and hold out great promise for
termination of pregnancies, etc. Upgradation of the any effort to change the population profile.
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Introduction development in any state are direct functions of its

State Total Fertility Rate (TFR) Per cent Decline in TFR

conditions, which often act as important inducements FIGURE 5.1

Total Fertility Rate

the twentieth century, with fertility limitation being FIGURE 5.2

Age-specific Fertility Rate

according to the SRS (Table 5.4, Figure 5.2). Two 200

successive rounds of NFHS, recording a rapid fall in 150

fertility in Himachal Pradesh during the 1990s, higher 100

than the national decline, also document lesser 50

contribution by younger women (age 15-29) than by 0

among women in the age group 44-49 years. Relatively

The age-specific mortality curve for Himachal

reducing the under-five mortality rate by two-thirds. The

A.P. 66 49.8 15.8 51.2 27.1 34.9 67.2 5.0

Source: 1. SRS Bulletin, Registrar General, India, April 2003.

management must recognise this and factor-in this FIGURE 5.4

Infant Mortality, India and Himachal Pradesh 125

Infant Mortality Rate

1971-1973 134 105 107 59 25

A.P. 60 46 23.3 26 20 23.1 86 65 24.4 30 17 43.3

Source: National Family Health Survey (1992-93 and 1998-99), India.

FIGURE 5.5 childhood, and reproductive life of females, unlike the

1.2 excess female mortality in particular, leads to a set of

Year All NFHS 2 Levels and Trends in Method Composition1

80 Age/Time Lag (in years) Type of Contraceptive

60 IUD Vasectomy Tubectomy

Mean age (of wife) at acceptance 1 27.5 29.7 28.1

among younger women, and make spacing methods, 0.15

Son-preference influences family planning acceptance 0

reservations one may have on the quality of such

State Sample Registration National Family Civil Registration System (CRS)

H.P. — — 107 108 114 116 118 115 117 117

Source: 1. Sample Registration System (SRS), Registrar General, India.

employment in non-agricultural activity and domestic

the developmental blocks and Panchayats. This can largely

campaigns are conducted all over the state to sensitise 15

Year CBR CDR Level of Efficiency

1996 19.6 23.0 4.9 8.0 85.4 61.0

2000 22.9 22.1 5.4 7.2 94.7 74.8

References Nanda, A.K. (2000), “Transferring Successful Programme Experience from

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