Emerging Issues: Ageing, Sex Ratios, Child And Infant Mortality, Reproductive Health

Ageing Issue in India

Introduction and Trends

Ageing is a natural and inevitable process characterized by a gradual decline in an individual's physical health, productivity, and social roles over time. In the Indian context, although the proportion of older persons (aged 60 and above) is relatively low at 8.6% as per the 2011 census, the absolute number of elderly people is substantial—around 104 million. Scholars define ageing variously: Becker describes it as the changes occurring over time in an individual; Stieglitz calls it an unavoidable part of life from conception to death; Tibbitts emphasizes that ageing refers to surviving beyond traditional adult roles such as earning a livelihood and raising children.

A significant social issue related to ageing is ageism, a term coined by Lorraine Green to describe systemic stereotyping and discrimination based on age. This prejudice particularly affects older adults, often leading to their marginalization, economic dependency, and reduced social participation.

Ageing manifests in two dimensions: physical ageing, which involves biological deterioration such as declining health and mobility, and social ageing, which refers to changes in societal roles and expectations, including retirement and economic dependence. These two processes may not always align; an individual may experience physical ageing but still maintain active social roles, or vice versa.

Changing Social Structure, Institutions, and Ageing

India’s rapid social transformation has significantly impacted the ageing population:

1. Transformation of Social Structure and Family Dynamics:
   Industrialization, urbanization, increased education, and globalization have altered traditional Indian social structures. The once-dominant joint family system, which ensured care and support for the elderly, is weakening. Intergenerational ties that were foundational for elderly care are eroding, leaving many older adults vulnerable and isolated.

2. Economic Role and Migration:
   Economic shifts towards individual transactions and income disparities within families have undermined the traditional family support system. Furthermore, migration of young adults to urban areas in search of better opportunities weakens familial support, especially in rural regions where many elderly reside.

3. Elder Care Challenges:
   With the shift towards nuclear families and urban living, elder care is becoming more problematic. The joint family’s system of mutual support is giving way to neglect and abuse, both within families and in the broader society, as elderly people lose their traditional roles and networks.

4. Social Role Transitions of the Elderly:
   Older adults traditionally transferred knowledge and skills in agrarian societies, a role diminished by technological advancement and changing work structures. Many elderly individuals feel alienated or worthless post-retirement, particularly when their children no longer seek their advice or caregiving.

5. Nuclear Families and Changing Values:
   The rise of nuclear families emphasizes independence and privacy, often resulting in elderly parents being left lonely or without adequate caregiving, especially when children migrate to cities. Economic pressures may force elderly people to continue working despite physical limitations.

6. Dual-Career Families and Impact on Elderly Care:
   With both parents working in many families, especially urban ones, caregiving responsibilities become difficult to manage. Elderly parents may provide emotional support but face challenges related to their own financial and physical care needs.

Ageing as a Challenge in India and Problems Faced by the Elderly

India faces several challenges related to its ageing population:

1. Increase in Number of Elderly:
   The elderly population is projected to grow rapidly, from 104 million in 2011 to 225 million by 2036 and 425 million by 2061. This demographic shift will place increasing demands on social, economic, and health systems.

2. High Pace of Ageing:
   Compared to other countries where population ageing took decades, India is experiencing this transformation at a much faster rate. While France took 110 years for its elderly population to double, India will undergo this change in just 20 years. By 2061, one in four Indians will be aged 60 or older.

3. Regional Disparity:
   The proportion of elderly varies across states. Southern states like Kerala have a higher elderly population (12.6% in 2011), whereas northern states like Bihar have lower percentages (7.4% in 2011). This disparity is expected to widen, necessitating region-specific policies.

4. Poverty and Economic Dependency:
   More than half of India’s elderly are economically dependent on others, with 52% fully dependent and 18% partially dependent. Many continue to work out of necessity, such as through government schemes like MGNREGA, where nearly 10% of workers were aged 61 or older in 2019-20.

5. Lack of Social Protection:
   With 90% of the workforce in the informal sector lacking social security, many elderly individuals have insufficient savings or pensions, leading to financial insecurity.

6. Inadequate Service Coverage:
   Only about 20% of the elderly have social security coverage, and 25% possess health insurance. Most pensioners spend their pensions on basic needs, highlighting the limited reach of social welfare.

7. Health Issues and Disability:
   Chronic health conditions and disabilities are prevalent among the elderly. Around 10% of those over 60 suffer from immobility, and 50% of those over 70 face chronic illnesses. Disability rates among the elderly are more than double the general population.

8. Social Problems:
   The transition in social roles can lead to alienation, especially as traditional roles like knowledge transfer lose relevance in modern societies.

9. Feminization of Ageing:
   Women constitute an increasing share of the elderly population due to higher life expectancy. In 2015, women made up 52.5% of the elderly, projected to rise to 53% by 2050. This demographic trend brings challenges such as widowhood, income insecurity, and lower lifetime earnings for women.

10. Violence Against Elders:
    Abuse and neglect of elderly people are rising concerns, often exacerbated by isolation and economic dependency.

11. Sex Ratio Trends:
    India’s historically skewed sex ratio is showing signs of improvement, with the ratio moving closer to the natural balance, which may impact future ageing demographics.

New Findings and Persistent Challenges in India’s Sex Ratio at Birth: Causes, Consequences, and Policy Solutions

India’s sex ratio at birth has long been a subject of deep concern due to its artificial skewing in favor of boys, a consequence primarily attributed to sex-selective abortions facilitated by prenatal diagnostic technology since the 1970s. Historically, before the advent of these technologies and legalization of abortion in 1971, the natural sex ratio at birth hovered around 105 boys per 100 girls. However, with increasing accessibility to prenatal sex determination tests, this ratio widened alarmingly—reaching 108 boys per 100 girls by the 1980s and 110 by the 1990s, signaling widespread female feticide. The Indian government responded with various interventions, including banning prenatal sex tests and initiating campaigns such as "Save the Girl Child," aimed at curbing the practice. Encouragingly, recent data from the National Family Health Survey reveals a gradual narrowing of this gap, with the ratio improving from 111.2 boys per 100 girls in 2011 to around 108 in 2019-21, suggesting a positive shift in societal attitudes. This improvement aligns with broader social changes like rising education levels and urbanization, which are fostering more gender-equitable perspectives. Nonetheless, the sex ratio remains above the natural baseline, underscoring that son preference and sex-selective practices persist, especially in rural areas where traditional norms are deeply rooted.

The reasons behind this skewed ratio are complex and deeply entrenched in India’s socio-cultural fabric. Chief among them is the preference for sons, driven by economic, religious, and social considerations. Sons are traditionally viewed as carriers of family lineage, responsible for performing key religious rites and inheriting property, while daughters are often perceived as economic burdens due to dowry practices and the expectation that they will join their husband’s family post-marriage. The availability of sex-selective abortion technologies has exacerbated this preference, leading to millions of "missing" female births. Further compounding the problem are issues like violence against females, fear for daughters’ security, patriarchal norms, and lack of consistent political will to enforce laws strictly. Practices like under-reporting of female births and skewed mortality rates also contribute to the distorted demographic picture.

The consequences of a low sex ratio are profound and multifaceted. Regions with a shortage of women have witnessed the importation of brides from poorer states, sometimes resulting in forced marriages and social marginalization. The gender imbalance fuels increased violence against women and reinforces patriarchal structures by diminishing women’s presence and influence in society. Economically, the deficit of women hampers workforce participation and national growth, with estimates suggesting that closing this gender gap could significantly boost India’s economy. Moreover, a sustained low sex ratio threatens long-term demographic stability by reducing the net reproduction rate, creating a vicious cycle of gender imbalance.

Addressing this complex challenge requires a multifaceted approach that combines legal enforcement with social and behavioral change. Government policies must focus on shifting societal attitudes through awareness campaigns that challenge son preference and promote the value of daughters. Incentives such as financial allowances for families with girls, support for widow remarriages, and benefits for dowry-free marriages can help dismantle economic motivations behind gender bias. Strengthening girls’ education and economic empowerment through schemes like Beti Bachao Beti Padhao and Sukanya Samriddhi Yojana is crucial for breaking the cycle of discrimination. Moreover, strict implementation of laws such as the Pre-Conception and Pre-Natal Diagnostic Techniques (PC-PNDT) Act is essential to prevent sex-selective abortions. Ultimately, the way forward lies in fostering a cultural transformation that recognizes daughters as equal contributors to family and society, ensuring balanced growth and social justice for future generations.

REPRODUCTIVE HEALTH IN INDIA

Sexual and Reproductive Health and Rights (SRHR), as defined by the World Health Organization (WHO), encompass access to healthcare services, information, and autonomy in making decisions about one’s reproductive life. These rights are recognized as fundamental human rights—universal, indivisible, and undeniable. The focus of SRHR is broad, addressing health conditions such as maternal mortality and morbidity by ensuring individuals have access to appropriate healthcare services, contraceptives, comprehensive education, and the freedom to make informed choices regarding their reproductive health.

Reproductive health and rights refer to an individual’s ability to decide freely and responsibly on matters related to reproduction. This includes family planning—deciding the number and timing of children—access to contraception, safe abortion services, sex education, and authority over reproductive choices. These rights are vital for promoting gender equality and improving public health outcomes.

India faces multiple, complex challenges in reproductive health, rooted in deep socio-cultural traditions, institutional weaknesses, and gaps in policy implementation. Despite efforts and policy frameworks aimed at improving SRHR, several persistent problems continue to hamper progress. Child marriage remains widespread despite legal prohibitions, driven by entrenched cultural norms, economic pressures, and lack of education. Early marriage is a significant contributor to maternal deaths, with India accounting for 20% of global maternal fatalities, many resulting from complications in young mothers.

The burden of contraception disproportionately falls on women, often under coercive circumstances, especially where female sterilization targets dominate policy agendas. Women frequently lack access to the full spectrum of voluntary, safe contraceptive options, limiting their reproductive autonomy. Historically, Indian reproductive health policies have emphasized population control rather than women’s rights, often requiring spousal consent for reproductive health services, which undermines female autonomy. This gender bias extends to discriminatory treatment in public healthcare settings, particularly affecting marginalized women, where poor quality care and lack of dignity dissuade many from seeking medical assistance.

Sexuality remains a taboo topic in many Indian communities, impeding open discussion about reproductive health, contraception, and menstrual hygiene. This cultural reticence, combined with a severe lack of sex education—only 15% of Indian youth reportedly receive such education—results in poor awareness and increased risks of sexually transmitted infections (STIs), unintended pregnancies, and unsafe abortions. Menstrual health is another critical area of concern, with a large proportion of women unable to access sanitary products due to economic barriers and social stigma, a phenomenon referred to as period poverty. This results in adverse health effects and social exclusion for many women.

Compounding these challenges is the lack of consistent political will, leading to underfunded programs, inadequate leadership, and patchy implementation of existing policies aimed at improving reproductive health.

Addressing these issues requires comprehensive, multifaceted solutions. Foremost is granting women full reproductive rights: the right to decide freely on marriage, family planning, contraception, pregnancy, and childbirth without coercion. Women must be guaranteed freedom from gender-based violence and access to quality healthcare for reproductive and sexual health issues, including prevention and treatment of STIs.

Awareness and education are essential. Initiatives should include community education platforms and widespread media campaigns to normalize discussions around reproductive rights and health. Integrating human rights education in school curricula will empower young people with knowledge about consent and reproductive autonomy.

Policy reforms must focus on women-centric approaches that prioritize reproductive autonomy over demographic targets. The landmark Puttaswamy judgment (2017) affirms the constitutional right to reproductive privacy, dignity, and bodily integrity, and such legal recognition must translate into gender-sensitive laws and policies with effective enforcement.

Sensitization of healthcare providers, law enforcement, and judicial officials through gender-sensitive training will reduce discrimination and improve care quality. Strengthening public-private partnerships can enhance accountability and resource mobilization for reproductive health programs.

Finally, sustained political commitment at the highest levels is crucial. This entails increasing budgetary allocations, promoting gender equality in governance, and fostering leadership dedicated to women’s reproductive health rights.

In conclusion, reproductive health in India remains a critical area requiring urgent and sustained action. Empowering women through rights-based approaches, education, policy reforms, and social change is fundamental to improving health outcomes, achieving gender justice, and fulfilling the promise of reproductive health as a human right.

Demographic Dividend and India: Challenges and Solutions

India stands at a critical juncture in its demographic transition, presenting a unique opportunity to harness its demographic dividend for accelerated economic growth and development. The demographic dividend refers to the economic potential that arises when the working-age population (generally between 15 to 64 years) surpasses the non-working-age groups such as children and the elderly. According to the United Nations Population Fund, this shift in age structure can fuel economic progress if supported by appropriate policies and investments. India entered this favorable phase around 2005-06, and this window is expected to remain open until about 2055-56, with the peak working-age population projected between 2021 and 2041. However, the realization of this dividend is contingent upon overcoming several socio-economic and structural challenges.

One of the foremost challenges impeding the demographic dividend in India is related to health. Data from the National Family Health Survey (NFHS) reveal alarming statistics such as 35.5% of children being stunted and 57% of women aged 15-49 suffering from anemia. These health issues severely affect the future productivity and contribution of the workforce. Alongside health concerns, the quality of education remains a critical bottleneck. Despite high enrollment rates, many children lack basic literacy and numeracy skills, as documented in the Annual Status of Education Reports (ASER). The higher education system also struggles with low enrollment and quality issues, limiting the pool of skilled individuals necessary for economic transformation.

Another significant challenge is the pronounced skills gap within India’s labor force. Currently, only about 3% of workers receive formal vocational training, making it difficult for the workforce to transition into skilled jobs in the secondary and tertiary sectors. Coupled with this is the issue of low public spending on health and education, which further undermines efforts to improve human capital. Unemployment, particularly among youth, exacerbates the problem. Contrary to expectations that the workforce would move from agriculture to industry and services, the proportion engaged in agriculture has increased in recent years. Protests such as those against the Agnipath scheme reflect widespread youth dissatisfaction with the availability of quality employment opportunities.

Addressing these multifaceted challenges requires a comprehensive and strategic approach. A key solution is the formation of a High-Level Task Force, led by the Prime Minister, which would include experts from health, education, development sectors, and industry. This task force would periodically review progress and recommend policy adjustments to ensure that India capitalizes on its demographic dividend. Special emphasis should be placed on populous north-central states like Bihar, Uttar Pradesh, Madhya Pradesh, West Bengal, and Maharashtra, which are projected to account for over half of India’s population growth in the coming decades.

Migration patterns also pose challenges and opportunities. While northern states will experience an increase in the working-age population, southern states face aging populations, leading to migration of youth from less developed to more developed regions. Policies must facilitate smooth workforce mobility and integration to maximize economic benefits. Additionally, India must prioritize skill development and empowerment by expanding vocational training programs and aligning education with the demands of modern industries. Lessons can be drawn from countries like South Korea, Germany, and Japan, which have successfully leveraged skilled workforces for industrial growth.

Education reform is equally vital, focusing on improving quality across all levels, retaining students, and promoting scientific and technological education to prepare India’s youth for future jobs. Nutrition and health interventions, especially targeting child malnutrition and maternal health, are critical to building a healthy and productive workforce. Moreover, enhancing women’s participation in the workforce through better access to education, skill training, and employment opportunities can help offset the shrinking workforce in the future.

Finally, alternative approaches to labor force training should be considered, such as expanding vocational education and creating mass employment opportunities in labor-intensive sectors like electronics and automobile manufacturing. This strategy, inspired by China’s experience, could generate large-scale employment and contribute significantly to India’s economic growth.

In conclusion, India’s demographic dividend offers a historic opportunity to accelerate development, but it is not automatic. Success depends on addressing health, education, employment, and gender-related challenges through coordinated policy action, investments, and social reforms. With the right focus and political will, India can transform its demographic potential into sustained economic prosperity.