​The price of success: On Kerala’s demographic transition

There can be too much of a good thing, after all. The demographic transition that Kerala has heralded in the country has now delivered a sucker punch to the State, with its maternal mortality ratio climbing. Kerala led the shift to the phase of low fertility and low mortality in India, and got further, first. As the fertility level dropped, the number of births came down, thereby skewering the best maternal mortality rate (calculated as the number of deaths for every 1,00,000 live births) of the country, in Kerala. The State led the demographic transition by achieving the total replacement level fertility rate in 1987-88, and the other southern States followed in the mid-2000s. A TFR of 2.1 is considered the replacement level, indicating the number of children a woman must have in order for the society to maintain its size across generations. Below this level the population size falls. In fact, this has led to moments of anxiety, politically for the southern States that feel that with their sub-replacement level fertility rates, they will be at a disadvantage when it comes to the proposed delimitation exercise of Lok Sabha seats based on population figures. In theory, demographic transition occurs when a historical shift happens from high birth rates and high death rates to low birth and death rates, aided by advancements in education, economic development and technology. Such a transition is said to have occurred in most parts of the world, allowing the world to stabilise from the unprecedented growth forecast by Malthus, and then move on to reduce population growth, and birth rates. The theory posits four stages – moving from stable population to a rapid population growth, levelling out and finally, a decline.

Nations that have reached there, including South Korea, are struggling to revive population growth, and even incentivising childbearing does not seem to have the intended effect, as the fertility rate continues to drop. While it is impossible to stop a demographic transition in its tracks, governments must prepare for the trail of consequences that it will bring in its wake. There will be far-reaching economic and societal consequences as the proportion of the working-age population comes down and the aged population increases, placing an inordinate burden on the resources of nations. It is, therefore, important to strengthen public finances and social support systems in preparation for a growing elderly population. Health-care financing will have to be improved, and policies that support equal participation in household chores must be prioritised.