The other day I was sifting through many, many documents to try to find out at what age women typically have their first child in Tamil Nadu. Given that maternal and child health seems to be one of the few health areas that gets attention and resources, I wondered whether there might be an opportunity to combine the area that I’m researching (cardiovascular health) with reproductive health visits. People here are suffering from ill heart-health about 10 years earlier than their counterparts in developed countries, and issues like pre-diabetes start much earlier than you might expect.

Anyway, Tamil Nadu has comparatively good health statistics in relation to other Indian states. The total fertility rate (number of children a woman will have in her lifetime, on average) is below 2 (the “replacement level” for a parent couple), and very young childbearing is uncommon. However I was shocked when I came across a figure like this one.


Source: International Institute for Population Sciences (IIPS) and Macro International. 2008. National Family Health Survey (NFHS-3), India, 2005-06: Tamil Nadu. Mumbai: IIPS.

More than half of currently married women are using sterilization for contraception, while 39% are using no method at all. Why aren't people using less invasive ways to limit family size - especially male sterilization, which is also reversible? The current pattern of closely spaced births in early adulthood is likely still contributing to an adverse population growth pattern, even if the overall number hits the target of less than two. Why not a greater emphasis on methods that help you to space out your children, which is known to improve the health of mothers and children? Targets can’t substitute for quality care and reasonable reproductive choice.

A little more reading on the issue here