Cairo Door Ast? Population Policies and their Context in India after LCPD

The ICPD advocated a new approach to population policy in the Plan of Action, one that was not demographically driven, but instead emphasised the empowerment of women, and an approach to reproductive health care. Reflecting this, the National Population Policy (NPP) enunciated in 2000 was premised upon the reproductive and child health (RCH) approach, though to the neglect of primary health care. Thus, it was not framed in demographic terms, and was committed to a voluntary, target-free approach that abjured incentives and, in particular, disincentives. Yet even before this approach, with all its limitations, could be given a fair chance, there was already manifest impatience, a call for giving greater teeth to the programme, reflected in a slew of policy initiatives with various disincentives and a two-child norm to contest elections to the panchayats. At the same time neo-liberal economic policies implemented over the same period have meant that health budgets have been substantially reduced, leading to the collapse of the already underfunded system of health care. It would thus not be an exaggeration to say that what we have is a situation of state-led collapse of the public health system, just as we have had state-induced growth of the largest and least regulated private health sector in the world. Data also indicates deceleration of employment in both rural and urban areas, a significant casualisation of the workforce, especially that involving the female labour force, and a sharpening of income inequalities with a contraction of incomes in the lower deciles of the population. Per capita calorie consumption has also declined. Thus, as health care becomes more inaccessible, expenditure on health care is emerging as the leading cause of indebtedness. Together these explain the stagnation we witness in health indices such as the infant and child mortality rates. Along with the spread of Hindutva ideologies, state policies are also actively contributing to the reinforcement of anti-female ideologies and engendering masculinity, reflected in the steep decline in the child sex ratio and the sharp increase in violence against women. It would thus perhaps not be an exaggeration to state that despite Cairo, the more things change, the more they remain the same.