Kerala needs to focus on challenges emerging from the demographic transition as the strategies adopted by the State now will determine the future course of transition, says a recent study by the Centre for Socio-Economic and Environmental Studies, Kochi. Given its early onset, demographic transition in Kerala is now at the matured stage with fertility below the replacement level, life expectancy at birth above 75 years, decadal growth rate of population at 5 percent during 2001-2011 with negative growth in two districts. The demographic advantage has created certain unique challenges for the state that are yet to be visible at the national level. The study by Dr. Baishali Goswami, Associate Fellow of CSES aims to synthesize the current trajectory of the transition in the state in light of the existing trends experienced worldwide with regard to advanced mortality and fertility transitions.
Fertility Transition and Familism
The state achieved the replacement level of fertility of 2.1 children per woman in 1988. Achievement of below replacement fertility in Western countries and more recently in several east and south-east Asian countries was soon followed by social changes like clear postponement of marriage and childbearing with fertility falling far below the replacement level, rising divorce rates, disruption of nuclear families and an increase in pre-marital cohabitation, bringing in a new era of demographic transition, referred as second demographic transition (SDT). In the Asian context, cohabitation being socially uncommon and marriage and child bearing being intimately related, it is predominantly the change in marriage and childbearing trends within marital unions that has governed the post-replacement fertility trends.
Kerala, in contrast, has exhibited a sluggish nature of fertility transition after attaining replacement level. Fertility declined from four children per woman in 1971 to two children per woman in 1988, just within less than two decades. Since then TFR is hovering around 1.7 to 1.9 children per woman for over three decades showing limited signs of rapid decline in the post-replacement transitional phase. According to National Family Health Survey (2015-16), median age at first marriage among women in 25-49 age group is 21.5 years, percentage of never married women is merely four percent and no significant change in divorce rate. Postponement of parenthood within the marital union through delayed first birth is increasing, albeit at a slow pace. Hence, unlike the demographically-advanced Asian countries, institutions of marriage and family still have high relevance in the post-transitional Kerala society. The study points out a possible application of the strong sense of ‘familism’, often used by demographers to explain the fertility experience of Southern European countries, has its relevance in the Kerala society. It is argued that a key factor like ‘familism’- a family-centred welfare system, a family-based production system and a family-oriented value system may have postponed the onset or full experience of the second demographic transition in Kerala. However, educational advancement, especially among women, may change the value system in tandem with that of Second Demographic Transition, favouring more egalitarian gender roles and subsequent changes in the institutions of marriage and childbearing in post-transitional Kerala society. Below replacement or an ultra-low fertility (TFR at or below 1.3) and the resulting consequences of rapid ageing or negative growth rate of population have their own demographic repercussions. The state needs to recognize this at the earliest to create a conducive environment of non- family-based support systems as well so that the present level of TFR can be sustained.
Age Structure transition: In-migration of Young workers
The change in fertility and mortality rate has brought significant changes in the age composition of the population following which Kerala society is increasingly becoming an ageing society. More importantly, the share of the young workforce (aged 20-34 years) in working age population has come down drastically from 50 per cent in 1991 to 39 per cent in 2011 and census-based population projections indicate that the downward movement will continue in the coming years. The decline in the young workforce led to shortage of young workers, especially for physical labour. Scarcity of semi-skilled/unskilled workers coupled with higher wage, sustained opportunities for work, and relatively better treatment of migrant workers in the state have made Kerala an attractive destination for labourers from other states. The study notes that the future pace of transition, therefore, will be determined by how fast the in-migrants are integrated with the current level of human development of the state.
Emerging Trends in Mortality Transition
The study points out that, despite a long history of mortality transition coupled with an advanced epidemiological transition, Kerala is yet to reach the advanced stage of mortality transition with mortality concentrated in ages 80 years and above. Kerala successfully prevented infectious and communicable diseases at the early stage of the transition and ensured better longevity for its population. Life expectancy at birth has increased from 62 years in 1970-75 to 72 years in 1996-2000 and then to 75 years in 2014-18.Reduction in mortality was mainly concentrated in the early years of life. To sustain this, the state now needs to focus on the health problems of adulthood that are much harder to prevent, in an age-disaggregated manner, says the study.
With mortality transition, Kerala experienced obvious shift in the disease pattern from communicable to non-communicable diseases (NCD) and emerged as the state experiencing highest level of epidemiological transition in the country. Between 1990 and 2016, NCD accounts for three-fourths of the total burden of diseases in the state and thus shifted the mortality up to mid-seventies. The changing disease pattern and the resulting gain in longevity confirm that the state has reached the third and final stage (namely the age of degenerative and man-made diseases) of classic mortality transition. However, mortality experiences in many developed countries have already established a ‘fourth stage’ known as the ‘age of delayed degenerative diseases’ with deaths concentrated mostly in ages 80 and above, irrespective of gender.
Given the global experience, the study highlights that there remains untapped potential in the state to postpone the age-specific mortality from degenerative diseases from the current age group of 70+ further to the advanced age group of 80+. Improved survival in the advanced age groups is often considered as a function of medical advancements and improved public health intervention targeting elderly. Kerala, being the state with the highest proportion of elderly among the Indian states, has already started recognizing the unique health needs of ‘elderly’ as a group. The study calls for further refinement in strategies targeting interventions to address the intra-group differentials in mortality to postpone the death rates to advanced ages of 80 and above. This also calls for age-sex disaggregated data across major killer diseases in the advanced age groups. This would not only provide a better understanding of the transitional process but also throw light on the changing disease pattern or emergence of new major killers, if any, in the ‘oldest’ age groups of 80+ years, says the study. It is high time for the state to learn from international experiences where failure to grapple with man-made and degenerative diseases led to long-term stagnation or reversal in the trend of adult death.
For more information: Please contact Dr. Baishali Goswami, Associate Fellow CSES : Mob. 9446412700