Large demographic disparities

10South Asian countries are of very unequal size (Table 3). The population of the Maldives (306,000 inhabitants) bears no comparison with that of India (1,169 billion inhabitants in 2007). Three of the region’s eight countries account for 95% of the total population, and nearly three-quarters of the region’s inhabitants live in India. South Asian countries also differ in terms of population density, which ranges from more than 1,100 inhabitants per sq.km in Bangladesh, to an average of just 14 inhabitants per sq.km in Bhutan.

Table 3

Population, surface area and density in South Asian countries in 2007

Country Number of inhabitants (thousands) Land area* (thousand sq.km) Population density (inhab. per sq.km) Maldives 306 0.3 1,020 Bhutan 658 47.0 14 Sri Lanka 19,299 66.0 292 Afghanistan 27,145 652.0 42 Nepal 28,196 147.0 192 Bangladesh 158,665 144.0 1,102 Pakistan 163,902 796.0 206 India 1,169,016 3,287.0 357 * Total surface area minus inland waters. Sources : United Nations (2007a) and Pison (2007).

Population, surface area and density in South Asian countries in 2007

11The population of these countries is growing at a variable pace. According to UN estimates, the average rate of population growth in Afghanistan was nearly 3.8% for the period 2000-2005, compared with scarcely more than 0.4% for Sri Lanka. The progress of demographic transition is also different. Infant mortality was estimated at 11‰ in Sri Lanka in the early 2000s, but exceeded 160‰ in Afghanistan, whereas fertility, which fell to only 2 children per woman in Sri Lanka is closer to 7 in Afghanistan.

12Within India proper (Map 2), there are considerable demographic disparities in terms of population size, rate of population growth and population density, to name just three criteria. For example, in the 2001 census, the most densely populated state in the country, Uttar Pradesh, had a population of 166 million – larger than that of Pakistan or Bangladesh – whereas the least populated state, Sikkim, had population of scarcely more than 540,000. The Union territory [5] of the Lakshadweep Islands has the smallest population, with just over 60,000 inhabitants in 2001 (Table 4). In the period 1991-2001, the population in India’s various states and territories grew at variable rates, with an annual average of 5% in Nagaland, 3.8% in the Territory of Delhi, 1.8% in Punjab (a rate close to the Indian average, which is 1.93%), 1.3% in Andhra Pradesh and 1.1% in Tamil Nadu. Population density also varies sharply between regions. In 2001 it stood at 324 inhabitants per sq.km for India as a whole, but just 13 per sq.km in Arunachal Pradesh, a state that stretches from the Himalayan mountains to the Brahmaputra Valley, and exceeded 900 inhabitants per sq.km in West Bengal, partly because of the city of Calcutta. Population density is particularly high in the territories of Delhi and Chandigarh, (9,294 and 7,903 inhabitants per sq.km respectively) because of intense urbanization. But urbanization is not the sole reason for high population density. In Kerala, a state where only 26% of the population lives in urban areas, density exceeded 800 inhabitants per sq.km in 2001.

Map 2

Administrative India (states, union territories and neighbouring countries)

Administrative India (states, union territories and neighbouring countries)

Table 4

The 28 states and 7 union territories of India by population in 2001

State or union territory Population Population density (Inhabitants per sq.km) Lakshadweep Island* 60,650 1,894 Daman & Diu* 158,204 1,411 Dadra & Nagar Haveli* 220,490 449 Andaman & Nicobar Islands* 356,152 43 Sikkim 540,851 76 Mizoram 888,573 42 Chandigarh* 900,635 7,903 Puducherry* 974,345 2,029 Arunachal Pradesh 1,097,968 13 Goa 1,347,668 363 Nagaland 1,990,036 120 Manipur 2,166,788 107 Meghalaya 2,318,822 103 Tripura 3,199,203 304 Himachal Pradesh 6,077,900 109 Uttarakhand 8,489,349 159 Jammu and Kashmir 10,143,700 99 Delhi* 13,850,507 9,294 Chhattisgarh 20,833,803 154 Haryana 21,144,564 477 Punjab 24,358,999 482 Assam 26,655,528 340 Jharkhand 26,945,829 338 Kerala 31,841,374 819 Orissa 36,804,660 236 Gujarat 50,671,017 258 Karnataka 52,850,562 275 Rajasthan 56,507,188 165 Madhya Pradesh 60,348,023 196 Tamil Nadu 62,405,679 478 Andhra Pradesh 76,210,007 275 West Bengal 80,176,197 904 Bihar 82,998,509 880 Maharashtra 96,878,627 314 Uttar Pradesh 166,197,921 689 India 1,028,610,328 324 * Union territories. Source : Banthia (2001), http:// www. censusindia. net

The 28 states and 7 union territories of India by population in 2001

Sharp socioeconomic inequalities

13An examination of the three significant variables for a country’s development considered to play a vital role in a country’s demographic transition, namely literacy, GDP and urbanization, reveals sharp contrasts between the countries. For example, while nearly all women over the age of 15 years are literate in the Maldives (96%) and in Sri Lanka (nearly 90%), the literacy rate is below 50% in India, under 40% in Bangladesh, 35% in Pakistan and Nepal, and as low as 13% in Afghanistan (Table 5). Likewise, there is a three-fold difference in per capita income between Nepal (USD 1,490 in terms of purchasing power parity) and Sri Lanka (USD 4,390). And although the countries in the region are not yet heavily urbanized, considerable discrepancies exist nonetheless. The proportion of city-dwellers in Pakistan, the most urbanized country in the region, is three times higher than in Bhutan (36% versus 12%).

Table 5

Literacy, standard of living and urbanization in South Asian countries

Literacy rate of women aged 15 or over in the 2000s (%) Per capita GNI in USD (PPP) in 2004 Percentage urbanized in 2005 (%) Afghanistan 13 – 23 Bangladesh 41 1,870 26 Bhutan – 1,969 31 India 48 3,139 29 Maldives 96 – 34 Nepal 35 1,490 16 Pakistan 35 2,225 35 Sri Lanka 89 4,390 15 Sources : UNDP (2006), United Nations (2008).

Literacy, standard of living and urbanization in South Asian countries

14Like the demographic indicators, the socioeconomic indicators vary from one region to another in India. According to data from the 2001 census, with respect to the Indian average of 54%, female literacy rates range from below 34% in Bihar and approximately 88% in Kerala. The wealth of the states varies enormously as does the proportion of city-dwellers. In Goa, India’s most urbanized territory, the proportion is nearly 50%, compared with the other extreme of 10% in Himachal Pradesh.

15Population breakdown by religion is also highly diverse in South Asian countries, as shown in Table 6. In Bangladesh and Pakistan, the vast majority of the population is Muslim. In 2001, 90% of Bangladeshis were Muslim and, in 1998, more than 96% of Pakistanis. The population of Nepal is more than 80% Hindu, whereas Buddhism, the second religion in order of importance, now only accounts for just over 10% of the total population. Hinduism is also the majority religion in India (81%). There are other religions in India but with the exception of Islam (13% of the population), they are very much a minority. The proportion of Christians is just above 2% and that of Sikhs is even lower, while Buddhists account for less than 1% of the total Indian population.

Table 6

Population breakdown by religion in five South Asian countries (%)

Country Religion Hindu Muslim Buddhist Christian Sikh Jain Other(a) Bangladesh (2001) 9.2 89.6 0.7 0.3 – – 0.2 India (2001) 80.5 13.4 0.8 2.3 1.9 0.4 0.7 Nepal (2001) 80.6 4.2 10.7 0.5 – – 4.0(b) Pakistan (1998) 1.6 96.3 – 1.6 – – 0.5 Sri Lanka (2001) 7.8 8.5 76.7 7.0 – – – (a) Other religion or non-specified. (b) Of which 3.6% Kiranti. Sources : Census of India, 2001 ; Census of Pakistan, 1998 ; Census of Sri Lanka, 2001 ; Census of Nepal, 2001.

Population breakdown by religion in five South Asian countries (%)

16The other countries do not have detailed statistics on their religious composition. Afghanistan is an Islamic Republic and approximately four fifths of its inhabitants are Muslim. In Bhutan, Mahayana Buddhism [6] is the state religion. The law in Bhutan guarantees religious freedom, and Hinduism is practiced in certain areas of the country. This freedom is somewhat theoretical, however, with the government preventing the establishment of non-Buddhist missions in the country or the construction of non-Buddhist religious buildings. The Nepalese constitution describes the country as a "Hindu Kingdom" but Hinduism is not a state religion and in 2006 the House of Representatives declared Nepal to be a "secular state". Islam is the state religion in the Maldives, whereas in Sri Lanka more than three-quarters of the population on the island is Buddhist. Here the Muslim, Christian and Hindu communities each account for just 8% of the total population.

17Although four-fifths of the population of India is Hindu, the religious composition varies between states, and Hinduism is not the majority religion everywhere. The proportion is over 94% in Orissa, Chhattisgarh and in Himachal Pradesh (where it even exceeds 95%) but Hindus only represent 8% of the population in Nagaland and 4% in Mizoram which both have a majority Christian population. The proportion of Muslims, which was slightly over 13% in the country as a whole in 2001, is under 2% in Punjab, but close to 25% in Kerala and West Bengal, more than 30% in Assam, 67% in Jammu and Kashmir and 95% in the Lakshadweep Islands. There are few Christians in India ; nationally the figure stands at 2.3%, but this rises to 19% in Kerala, 27% in Goa, 70% in Meghalaya and 90% in Nagaland. Sikhs, who represent less than 2% of the Indian population, constitute 16% of the population in Chandigarh and 60% in Punjab. In India less than 1% of the population is Buddhist, but in Sikkim Buddhists account for more than 28%.

Frequent migration waves in the past

18Major population movements have occurred in the course of South Asia’s history, which explains the diversity of the populations in the various countries of the region. Afghanistan, located in the main path of the Central Asian invasions of south or southwest Asia [7], has a Pashtun majority but is also peopled by Tajiks, Hazaras, Uzbeks, as well as by Aimak, Turkmen and Baluch. The Nepalese are the product of three major migrations [8] from India, Tibet and Central Asia, while Bangladesh was settled by Turks, Arabs, Pashtun and Persians. Sri Lanka was uninhabited until a Prince of Bengal settled there around 540 BC with a suite of 700 persons who became the ancestors of the Singhalese people from whom most contemporary Sri Lankans are descended (CICRED, 1974b).

19From ancient times, many great civilizations occupied the vast territory that was India before the partition of West and East Pakistan in 1947 [9]. Population movements have played a major role in the rise and fall of civilizations. In the beginning of the third millennium BC, the Indus civilization flourished and extended from the Indian Punjab to the Arabian Sea. It derived its strength from its productive agriculture based on the rich alluvial soil and abundant water supplies, which provided numerous crops including cotton. Towns developed and there were numerous exchanges with Western civilizations, especially with Sumer and Egypt. This civilization disappeared around 1500 BC, probably because of the Aryan invasion or natural disasters [10] (ESCAP, 1982). Around 500 BC, the Aryan civilization developed and spread eastwards to the Ganges Valley. Agriculture also flourished and the population grew, partly as a result of new waves of Aryan migration from Central Asia. The Aryans pushed the Dravidians, who originally inhabited the Indus Valley, further south and the Dravidian civilization subsequently flourished in southern India. For a long time southern India was divided into numerous kingdoms engaged in incessant war against each other.

20In the north of India, the Maurya Empire extended from Afghanistan to Bengal via the southern Himalayas, and reached its apogee under Ashoka (273-232 BC). Then, from the early fourth century AD, the Gupta Empire extended from the Indus to the Brahmaputra Rivers to include a large part of the Indian peninsula. This region subsequently enjoyed 200 years of peace and political stability up to the invasion of the Huns at the end of the fifth century. The Mogul Empire followed from the sixteenth to seventeenth century, after which the Portuguese, Dutch, British and French traders arrived. The East India Company [11] established during the Mogul period greatly advanced Britain’s domination of India.

The British influence

21All the countries of South Asia have been subjected to strong British influence. In Afghanistan, the British fought the Russians for control of the country from the end of the 1830s. Between 1838 and 1842, the first Afghan war ended with the defeat of the British army, but in the second Afghan war of 1878-1880 the British army conquered Kabul and freed Kandahar. In 1919, a third Afghan war resulted in that country’s independence. After a war that was intended to control the expansionist aims of the Gurkhas, Nepal came under British rule in 1815 and remained so until 1923, when Great Britain recognized Nepal’s independence. The annexation of Assam by the British in the 1820s stirred up tensions on the Bhutanese border and conflicts ensued until a treaty was signed in 1910 that made Bhutan a British protectorate. From the mid twentieth century, Bhutan was largely under Indian dominance while Sri Lanka was under British rule from 1815 to 1948. It was the British who introduced tea plantations to the island that was then called Ceylon. The Maldives were a British protectorate from 1887 to 1965.

22India was almost entirely administered by the British from the mid nineteenth century until independence in 1947 [12]. The British unified the country, in particular by constructing a railway network. They carried out irrigation work, set up communications networks, developed the mining industry, cultivated jute and tea, etc. To get a clearer picture of the population on its territories, the British government conducted a first census, known as the 1872 census, but which in fact stretched over the period 1867-1872. The first detailed “instant” census was conducted in 1881. From that time until the present day, colonial India and later independent India has taken a census every decade, the most recent in 2001.

Population diversity and political tensions

23The political history of this region, like the diversity of its populations in terms of origin or religion, has given rise to numerous conflicts, some of which continue to this day.

24The independence of India and the partition of East and West Pakistan in 1947, resulted in major population movements, with Hindus migrating from Pakistan to India and Muslims settling in Pakistan [13]. In 1971, East Pakistan fought a “liberation war” with West Pakistan, accused of political and economic dominance, resulting in East Pakistan’s secession and the formation of Bangladesh in December of the same year. The problem of Kashmir remains a source of friction between India and Pakistan, who have clashed three times on that issue. Any changing or crossing of borders between Indian and Pakistani Kashmir always leads to confrontations, particularly since the Muslims on the Pakistani side tend to be increasingly radical. Afghanistan has also been at the heart of a series of conflicts over the past thirty years, with the Soviet invasion of 1979, the takeover by the Taliban in 1996, the toppling of their regime in the 2001 war, and incessant guerrilla warfare ever since. Sri Lanka has seen violent confrontations between the majority Singhalese population and the Tamils. The Maldives became a republic in 1968, but endured a coup 20 years later during which the Maldivians obtained help from the Tamils, themselves in conflict with the Sri Lankan authorities. However, with Indian help, the Maldives government resisted the coup. Bhutan suffered from ethnic violence between 1991-1993 and in India violence regularly erupts between various communities. The Indian government had to contain separatist Sikhs in the 1980s and considerable tensions have existed between fundamentalist Hindus and Muslims for nearly 20 years. Bangladesh is also subject to Islamist violence.

Sustained population growth

25In the early 1950s, the demographic growth rate in the South Asian countries (Appendix Table A.3) was twice as high in some countries as in others, ranging from 1.54% in Afghanistan to 3.09% in Bhutan. Several countries were at the higher end of the scale – Sri Lanka, with annual population growth of 2.8%, was not far behind Bhutan, and Pakistan, though growing more slowly, was still above 2%. During the following decades, all the countries except Sri Lanka witnessed an acceleration of their demographic growth. The annual growth rate in India rose from 1.73% in 1950-1955 to 2.26% thirty years later, in 1980-1985. During the same period, that of Bangladesh increased from 1.98% to 2.47% and that of Pakistan from 2.15% to 3.63%. Between 1980-1985 and 2000-2005, all the countries, with the exception of Afghanistan, recorded a slowdown in population growth (Figure 1). In Afghanistan, over the period 1980-1985, the natural growth rate was largely positive, but the war with the Soviet Union prompted massive migration of refugees to Pakistan and Iran that led to negative total population growth [14].

Figure 1

Population growth rate in South Asia between 1980-1985 and 2000-2005

Population growth rate in South Asia between 1980-1985 and 2000-2005

26Sri Lanka has proved to be an exception, with a steady decrease in the population growth rate since the early 1950s: from 2.8% in 1950-1955, it dropped to 2.1% in 1970-1975, 1.4% in 1980-1985, 1.1% in 1990-1995 and finally 0.4% in 2000-2005, i.e. a decline to virtually zero population growth in the space of fifty years (Appendix Table A.3).

27India, which set up its first family planning programme in the early 1950s has seen its population growth rate slow down over the past twenty years, though in 1990-1995 it was still above 2% per annum. Although the Indian authorities have been trying to stabilize the population growth rate for many years now, the figure was still 1.62% per annum in 2000-2005. During the same period, the population growth rates in Pakistan and Bangladesh remained above 1.8%, which means that if there is no change, the population of these countries will double in less than forty years. As a result of these high demographic growth rates over a period of a half a century, the population of South Asia tripled between 1950 and 2005, climbing from 478 million to 1,580 million inhabitants.

South Asia in 2040: a forecast increase of 600 million inhabitants

28According to the medium variant projections of the United Nations (2006 revision), the population in the region will continue to grow during the next few decades, reaching a total 2,200 million inhabitants in 2040, i.e. 600 million inhabitants more than today. Its share in the total world population will increase slightly, from 23.3% in 2005 to 25.3% in 2040. According to these mean variant projections, in thirty years time, India will have a population of 1,600 million inhabitants, Pakistan 268 million, Bangladesh 239 million, Afghanistan 66 million, Nepal 47 million, Sri Lanka about 20 million, Bhutan 900,000 and the Maldives 476,000. By then, India will be more populated than China, with its estimated 1,450 million inhabitants.

29Projections drawn up in India on the basis of the 2001 census and revised in 2006 lead to a slightly lower population in 2025 than the figure put forward by the United Nations (1,389 million against 1,447 million), but the difference – nearly 60 million – needs to be put into perspective, as it only corresponds to slightly more than two years of births in India. In 2026, the final year of these projections, it is forecast that India will have about 1,400 million inhabitants (Table 7). The most populated state, Uttar Pradesh, will have a population of 249 million inhabitants, equivalent to the entire population of India in 1911. Three other States will have more than 100 million inhabitants: Maharashtra (133 million), Bihar (114 million) and Western Bengal (101 million). Andra Pradesh, Madhya Pradesh [15] and Rajasthan will have 94 million, 88 million and 82 million inhabitants in 2026.

Table 7

Population of Indian States of more than 20 million inhabitants in 2001 (in thousands) projected to 1 March 2026

State Projected population in 2026 (thousands) Andhra Pradesh 94,073 Assam 35,602 Western Bengal 100,534 Bihar 113,847 Chhattisgarh 28,591 Gujerat 69,258 Haryana 31,087 Jharkhand 37,356 Karnataka 66,933 Kerala 37,254 Madhya Pradesh 87,729 Maharashtra 133,333 Punjab 31,345 Rajasthan 81,501 Tamil Nadu 71,857 Uttar Pradesh 248,763 India 1,399,838 Source: Office of Registrar General & Census Commissioner (2006). http:// www. jsk. gov. in/ projection_report_december2006. pdf

Population of Indian States of more than 20 million inhabitants in 2001 (in thousands) projected to 1 March 2026

The mean number of children per woman varies by a factor of two

40Fertility in all the countries of South Asia was still high in the early 1950s, ranging from 5.7 children per woman in Sri Lanka to 7.7 in Afghanistan (Appendix Table A.5). At that time, fertility rates were comparable in India and Nepal (5.9 and 6.1 children per woman), substantially higher in Pakistan, Bangladesh and Bhutan (6.6-6.7 children per woman), and even higher in the Maldives (7 children per woman) though still below the level for Afghanistan (7.7).

41Between 1950-1955 and 2000-2005, fertility declined sharply in all countries of the region, except in Afghanistan where, according to United Nations estimates, it continued to fluctuate between 7.5 and 8 children per woman. Over this fifty-year period, the mean number of children per woman fell by around 40% in Nepal and Pakistan, by 47% in India, by over 50% in Bangladesh and Bhutan, by 60% in the Maldives and by 65% in Sri Lanka. Women in Sri Lanka had slightly over 2 children on average in 2000-2005 and the fertility transition there is complete, whereas in Afghanistan it has yet to start. In the other countries the fertility transition is under way, though the process is more or less advanced depending on the country: today, the mean number of children per woman is 2.8 in the Maldives and 2.9 in Bhutan, 3.1 in India and 3.2 in Bangladesh, 3.7 in Nepal and 4.0 in Pakistan. Afghanistan is very much the exception (Figure 3).

Figure 3

Total fertility rates from 1960- 1965 to 2000-2005

Total fertility rates from 1960- 1965 to 2000-2005

42In most of the countries, women still begin their reproductive life very early, a fact related to early marriage and the notable absence of out-of-wedlock births (Table 9). In 2004, median age at first childbirth in Bangladesh was below 18, by which age nearly 33% of adolescents have already started childbearing. In India, on the basis of the NFHS-3 survey (2005-2006), median age at first childbirth is 20. The proportion of women aged 15-19 who have ever given birth rises rapidly with age: 1.3% at 15 years, 4.1% at 16, 8.6% at 17, 17.9% at 18 and 29.7% at 19 [17]. In Sri Lanka, however, childbearing begins much later and this is not a recent phenomenon: in 1987, mean age at first childbirth was already 24 years, and in 2000 it was 23 years.

Table 9

Median age at first birth (women aged 20-49) and proportion of adolescents (women aged 15-19) who have started childbearing

Median age at first birth (in years) Proportion of adolescents who have started childbearing (in %) 25-29 40-49 Afghanistan – – – Bangladesh (2004) 17.7 16.9 32.7 Bhutan – – – India (2005-2006) 19.9 20.2 12.1 Maldives – – – Nepal (2006) 19.6 20.1 21.4 Pakistan (1990-1991)* 21.0 22.6 5.7 Sri Lanka (2000) 23.2** – * The most recent DHS survey for Pakistan dates from 2006 but the results are not yet available. ** Mean age at first birth. Sources: DHS and NFHS-3 surveys.

Median age at first birth (women aged 20-49) and proportion of adolescents (women aged 15-19) who have started childbearing

43The patterns of age-specific fertility in 2000-2005 that emerge from the United Nations data reveal the progress of the fertility transition in each country of the region (Table 10 and Figure 4). The transition has not yet begun in Afghanistan, is complete in Sri Lanka, and is under way in the other countries of South Asia. The trend in age-specific fertility follows a similar course in the Maldives, India, Bangladesh, Bhutan and Nepal, although the rates at each age may differ. Pakistan differs from the other countries in having a substantially higher level of fertility from the 25-29 age group onwards, reflecting lower levels of contraceptive practice.

Table 10

Age-specific fertility rates in 2000-2005 in the countries of South Asia (‰)

Country Age 15-19 Age 20-24 Age 25-29 Age 30-34 Age 35-39 Age 40-44 Age 45-49 Afghanistan 131.9 356.9 378.3 276.9 195.8 101.3 54.7 Bangladesh 149.2 195.0 147.7 90.4 44.1 16.1 2.2 Bhutan 50.9 163.0 157.2 98.8 63.9 37.1 10.6 India 68.9 228.8 177.5 89.5 40.1 12.9 4.9 Maldives 26.2 146.2 162.6 123.7 75.2 22.7 4.8 Nepal 122.2 231.2 184.0 114.4 63.0 17.2 4.4 Pakistan 22.0 166.3 233.1 193.0 112.0 52.1 20.4 Sri Lanka 28.3 70.2 109.4 100.3 71.7 22.0 2.1 Source: United Nations, 2007a.

Age-specific fertility rates in 2000-2005 in the countries of South Asia (‰)

Figure 4

Age-specific fertility rates in 2000-2005 in the countries of South Asia

Age-specific fertility rates in 2000-2005 in the countries of South Asia

44Between a country at the end of the demographic transition, like Sri Lanka, and one still engaged in it, like India, the trends in age-specific fertility present sharp contrasts (Tables 11a and 11b; Figures 5a and 5b). In Sri Lanka, a fertility decline at all ages between 1963 and 2000 was explained by a high level of contraceptive practice (70% contraceptive prevalence in 2000), while relatively low fertility rates at younger ages are due to late marriage: the fertility rate is below 30 per thousand at ages 15-19 and slightly above 80 per thousand at ages 20-24. The main feature of the fertility trend in India is a decline after age 25. The age-specific fertility rate still stands at 90 per thousand at ages 15-19 in 2005-2006 and exceeds 200 per thousand at ages 20-24. The age-specific fertility curve for India is characteristic of a population in which contraceptive practice is well established but where later entry into childbearing, resulting from increased age at marriage and use of contraception in the early years of union, is not yet widespread. We will return to this point below. The fertility rate in Bangladesh is even higher than in India at ages 15-19 (135 per thousand in 2004) but slightly lower at ages 20-24 (192 versus 209 per thousand) and similar at ages 25-29. In Nepal, the fertility rate in 2006 is lower than in Bangladesh at ages 15-19 (close to 100 per thousand) but substantially higher, however, at ages 20-24 (234 per thousand). At ages 25-29, fertility is ten points higher than in India and Bangladesh.

Table 11a

Age-specific fertility rates in Sri Lanka between 1963 and 2000 (‰)

Age groups 1963 1975 1987 1993 2000 15-19 52 31 38 35 27 20-24 228 146 147 110 83 25-29 278 161 161 134 118 30-34 240 158 122 104 98 35-39 157 126 71 54 40 40-44 46 43 23 14 8 45-49 7 6 3 4 1 Sources: World Fertility Survey for 1975; DHS surveys for 1987, 1993 and 2000.

Age-specific fertility rates in Sri Lanka between 1963 and 2000 (‰)

Table 11b

Age-specific fertility rates in India between 1970-1972 and 2005-2006 (‰)

Age groups 1970-1972 1980-1982 1992-1993 1998-1999 2005-2006 15-19 103 89 116 107 90 20-24 254 246 231 210 209 25-29 259 231 170 143 139 30-34 203 165 97 69 62 35-39 134 100 44 28 25 40-44 63 46 15 8 7 45-49 27 21 5 3 3 Sources: SRS for 1970-1972 and 1980-1982; NFHS for 1992-1993, 1998-1999 and 2005-2006.

Age-specific fertility rates in India between 1970-1972 and 2005-2006 (‰)

Figure 5a

Age-specific fertility rates in Sri Lanka, 1963-2000 (‰)

Age-specific fertility rates in Sri Lanka, 1963-2000 (‰)

Figure 5b

Age-specific fertility rates in India between 1970-1972 and 2005-2006

Age-specific fertility rates in India between 1970-1972 and 2005-2006

45The surveys conducted since 2000 reveal fertility differences that vary by place of residence, but most markedly by women’s educational level (Table 12). While the urban-rural fertility differences are non-negligible: 0.7 children per woman in Bangladesh in 2004, 0.9 in India in 2005-2006 and 1.2 in Nepal in 2006, the differences by women’s educational level are very wide everywhere. In Bangladesh, women with no education have on average 3.6 children versus only 2.2 for the most educated women. In India, women with no education have identical fertility to comparable women in Bangladesh whereas highly educated women – with 12 years or more of education – currently have only 1.8 children. In Nepal in 2006, there is a difference of two children between women of the lowest and highest educational levels. In this region as in the rest of the world, education is a key variable in the fertility transition.

Table 12

Total fertility rate by women’s place of residence and educational level

Place of residence Educational level Urban Rural Illiterate Incomplete primary Completed primary or intermediate level Completed secondary or higher At least 10 years of education Bangladesh 1999-2000 2.45 3.54 4.12 3.30 3.42 2.40 – – 2004 2.50 3.20 3.60 3.30 2.90 2.20 – – India 1993 2.70 3.67 4.03 3.01 2.49 2.15 – – 1998-1999 2.27 3.07 3.47 2.64 2.26 1.99 – – 2005-2006 2.06 2.98 3.55 2.45* 2.51** 2.23*** 2.08**** 1.8***** Nepal 1996 2.85 4.83 5.08 – 3.78 2.51 – – 2006 2.10 3.30 3.90 2.80 2.30 1.80 – – Pakistan 1990-1991 4.90 5.60 5.70 4.90 4.50 3.60 – – * less than 5 years of education, ** 5-7 years of education, ***8-9 years of education, ****10-11 years of education, *****12 years or more of education. Sources: DHS and NFHS surveys.

Total fertility rate by women’s place of residence and educational level

46The changes in net reproduction rates [18] summarize the changes in mortality and fertility. With a net reproduction rate of 0.96 daughters per woman in 2000-2005 (Table A.5), it appears that the population of Sri Lanka is not quite replacing itself. Over the same period, the net reproduction rate for Afghanistan remained high, at around 2.3. For the other countries, the net reproduction rate is between 1.2 (Maldives and Bhutan) and 1.7 (Pakistan).

Fertility is linked to social and health development

47The inverse relationship between fertility and development is generally confirmed by a country-by-country comparison of total fertility rates for the period 2000-2005 with the human development index for 2004. The countries where fertility is highest tend to be those for which the development indicators are lowest (Figure 6). For example, fertility in Nepal and Pakistan is much higher than in Sri Lanka, while the human development index is much lower. However, this relationship is not very strong: the development indicators for Bhutan and Pakistan are virtually identical whereas the fertility difference between the two countries is of one child per woman; fertility in Bhutan is practically the same as in the Maldives (2.91 and 2.81 children per woman in 2000-2005, respectively), while the human development index shows a substantial difference (0.54 in Bhutan, 0.74 in the Maldives). The coefficient of determination R² for this relationship is slightly above 0.6.

Figure 6

Relationship between total fertility rate in 2000-2005 and human development index in 2004

Relationship between total fertility rate in 2000-2005 and human development index in 2004

48The correlation – positive this time – between fertility and infant mortality is also observed over the period 2000-2005. In Sri Lanka, low fertility is combined with low infant mortality, while in Afghanistan fertility and infant mortality are both high (Figure 7). The coefficient of determination is close to 0.98, indicating a particularly strong correlation. This positive correlation between fertility and infant mortality is observed in all world regions (Tabutin and Schoumaker, 2004; Tabutin and Schoumaker, 2005; Guzman et al., 2006).

Figure 7

Relationship between total fertility rate and infant mortality rate, 2000-2005

Relationship between total fertility rate and infant mortality rate, 2000-2005

49Fertility decline is related to economic and social development but can also result, at least partially, from the implementation of population policies. The case of India is interesting in this respect. In the early 1950s it was the first major country to initiate a family planning programme, and then to attempt a veritable population policy (Srinivasan, 1995). The pace of population growth accelerated in subsequent decades, and the targets, notably for the birth rate, proved over-ambitious and had to be revised several times (Rajan and Véron, 2006). This does not mean that the family planning programmes had no effect at all, since at this time India’s population was getting younger, with the consequence that the birth rate decreased less than fertility. However, without “modernization” [19], the fertility transition would certainly have been much slower (Visaria, 1995; Visaria and Visaria, 1995).

Wide disparities in fertility still exist in India

50At the regional level, the history of the fertility transition in India breaks down into three phases: an early fertility decline confined to Kerala state in the 1960s; emergence of a division between low fertility in the south and high fertility in the north in the 1970s and 1980s; a generalized decline in the subsequent period, though with large differences persisting in 2005.

51In the 1950s, fertility in India as a whole still stood at 6.3 children per woman [20], but it was already slightly lower – 5.6 children – in the southern Indian state of Kerala (Table 13). Kerala is the state where fertility declined earliest. The total fertility rate fell there to 5 in the period 1961-1971, while for India as a whole it held steady at 6 children per woman. The gap widened in the following years. According to the NFHS-2, fertility in Kerala was below 2 children per woman in the period 1996-1998. Indeed, for 1994 the Sample Registration System gave a value for fertility half that of the national value: 1.7 versus 3.5. The most recent survey (NFHS-3) finds a difference of 0.75 children per woman between Kerala and India as a whole. Many studies have attempted to explain the reasons for the singular course of fertility change in Kerala (Zachariah and Patel, 1984; Mari Bhat and Rajan, 1997). The high educational level of women and the political specificity of Kerala – a state that became communist in 1957 with the aim of reducing socioeconomic inequalities and improving the health of the population – have often been invoked to account for this earlier demographic transition. In reality, change was of an extremely general nature (Rajan and Véron, 2006). Improvements were indeed made in the education of women, but both age at marriage [21] and contraceptive prevalence also increased considerably. Programmes were also set up to promote maternal and child health, and in 1985 the government launched a programme of universal vaccination, one result of which was to make the population more familiar with the health services. This programme seems to have been as important as specific family planning initiatives in making couples give more thought to the “quality” of children, known to be a factor in fertility reduction (Zachariah et al., 1994). The state of Kerala did not have a particularly advanced level of economic development, nor was it highly urbanized. It offers an example of a transition linked not to economic development or urbanization but to changes in the social sphere, and in this sense it did not follow the standard pattern of transition. Thereafter, Kerala’s demographic singularity gave way to a north-south division of India.

Table 13

Fertility changes in Kerala and in India (number of children per woman)

Year Kerala India Censuses 1951-1961 5.60 6.30 1961-1971 5.00 6.00 1971-1981 3.40 5.20 SRS 1981-1985 2.60 4.50 1994 1.70 3.50 NFHS 1990-1992 2.00 3.39 1996-1998 1.96 3.39 1996-1998 1.96 2.85 2005-2006 1.93 2.68 Sources: Mari Bhat and Rajan (1997), SRS, NFHS, NFHS-2 and NFHS-3.

Fertility changes in Kerala and in India (number of children per woman)

52The fertility transition in India during the 1990s was characterized by large fertility differences between the country’s northern and southern states [22] (Nair and Véron, 2002). At that time, fertility in the southern states – Kerala, Tamil Nadu, Karnataka and Andhra Pradesh – was 2 children per woman, whereas women in the northern states – Uttar Pradesh, Bihar, Madhya Pradesh and Rajasthan – were still producing 3-4 children on average (Table 14). No single factor can account for these contrasts in fertility (Véron, 2000). Levels of infant mortality and fertility are certainly both lower in the southern states, but the changing relationship over time between these two indicators varies from state to state, as the covariation in these indicators over the period 1981-1994 shows. On Figure 8, each dot represents a combination of fertility and infant mortality at a given point in time, and each broken line plots the covariation in fertility and infant mortality in one state between 1981 and 1994. Over this period, the combined fertility and infant mortality values are consistently lower in the four southern states than in the northern states, and the two distinct groups are identified clearly in Figure 8. Thus the broken line furthest to the left on Figure 8 represents this covariation of fertility and infant mortality in Kerala between 1981 and 1994. It is seen that in some years fertility has fallen substantially without any clear reduction in infant mortality. Generally speaking, at state level, no close relationship between fertility and infant mortality is observed. Variation in one of these indicators may be accompanied by no clear change, or even by an increase in the other, thus producing a somewhat erratic trajectory over time. The other variables usually considered have equally limited explanatory power. Though the states in the north of India are less urbanized than those in the south, and fertility is invariably lower in urban than in rural areas, the degree of urbanization does not explain the fertility level in a state : Bihar is less urbanized than Uttar Pradesh, yet fertility was lower there in the early 1990s, and Kerala, though less urbanized than Tamil Nadu, also had lower fertility (Table 15). The scale of fertility differences between urban and rural areas varies widely within states. Rural fertility exceeds urban fertility by 8% in Tamil Nadu while the difference is 45% in Uttar Pradesh. A relationship also exists between female level of education and fertility : more educated women have fewer children. On its own, however, the educational level of mothers does not explain the fertility differences : in 1991-1992, fertility among illiterate women ranged, for a national average of 4 children, from 2.31 in Kerala to 5.36 in Uttar Pradesh. Fertility also rises with the proportion of people living below the poverty line. However, comparable proportions living below the poverty line (43% in Madhya Pradesh and 45% in Tamil Nadu) can be associated with very different fertility levels (3.9 and 2.5 children per woman, respectively). Equally, the differences in fertility between states are not explained by the religious composition of the population, even though at the national level the number of children per woman does vary by religion (with a difference of one additional child for Muslims relative to Hindus in 1990-1992). In Tamil Nadu, Muslim and Hindu women produce the same number of children, whereas the fertility of Hindus in 1990-1992 ranged from 1.7 children per woman in Kerala to 4.7 in Uttar Pradesh [23].

Table 14

Total fertility rate in the northern and southern states of India in the 1990s (number of children per woman)

Region and state 1980-1982 1990-1992 1996-1998 Northern states Uttar Pradesh 5.8 4.82 3.99 Bihar 5.7 4.00 3.49 Madhya Pradesh 5.2 3.91 3.31 Rajasthan 5.4 3.63 3.78 Southern states Andhra Pradesh 3.9 2.59 2.25 Karnataka 3.6 2.85 2.13 Tamil Nadu 3.4 2.48 2.19 Kerala 2.9 2.00 1.96 India 4.5 3.39 2.85 Sources : Visaria (2004), NFHS and NFHS-2.

Total fertility rate in the northern and southern states of India in the 1990s (number of children per woman)

Figure 8

Covariation in infant mortality and fertility in the northern and southern states of India, 1981-1994

Covariation in infant mortality and fertility in the northern and southern states of India, 1981-1994

Table 15

Urbanization and fertility in India in the early 1990s

Region and state Percentage urban Total fertility rate (number of children per woman) Ratio of rural fertility to urban fertility* Urban areas Rural areas Northern States Uttar Pradesh 19.9 3.58 5.19 145 Bihar 13.2 3.25 4.15 128 Madhya Pradesh 23.2 3.27 4.11 126 Rajasthan 22.9 2.77 3.87 140 Southern States Andhra Pradesh 26.8 2.35 2.67 114 Karnataka 30.9 2.39 3.09 129 Tamil Nadu 34.2 2.36 2.54 108 Kerala 26.4 1.78 2.09 117 India 25.7 2.70 3.67 136 * Ratio of mean number of children per woman in rural areas to mean number of children per woman in urban areas (as a percentage). Sources : census of 1991 ; NFHS 1992-1993.

Urbanization and fertility in India in the early 1990s

53The most recent data for India, taken from NFHS-3, show persistently strong spatial disparities in fertility, ranging from 1.79 children per woman in Goa and Andhra Pradesh to 4 in Bihar (Table 16). Replacing the north-south division of India by a finer geographical subdivision – that splits the country into north, centre, east, north-east, west and south – does not cause any homogeneous regions to appear although the previous demarcation lines disappear. Thus, under the partitioning for NFHS-3, what is termed the north region contains Himachal Pradesh where fertility was 1.94 children per woman and Rajasthan where it was 3.21 children per woman. In the north-east region, fertility ranges from 2.02 in Sikkim to 3.80 in Meghalaya. The southern states, however, remain relatively homogeneous in terms of fertility, which is everywhere at sub-replacement level.

Table 16

Total fertility rate (number of children per woman) in the states of India in 1990-1992, 1996-1998 and 2005-2006

State 1990-1992 1996-1998 2005-2006 North Delhi 3.02 2.40 2.13 Haryana 3.99 2.88 2.69 Himachal Pradesh 2.97 2.14 1.94 Jammu and Kashmir – 2.71 2.38 Punjab 2.92 2.21 1.99 Rajasthan 3.63 3.78 3.21 Uttarakhand – – 2.55 Centre Chhattisgarh – – 2.62 Madhya Pradesh 3.90 3.31 3.12 Uttar Pradesh 4.82 3.99 3.82 East Bihar 4.00 3.49 4.00 Jharkhand – – 3.31 Orissa 2.92 2.46 2.37 West Bengal 2.92 2.29 2.27 North-east Arunachal Pradesh 4.25 2.52 3.03 Assam 3.53 2.31 2.42 Manipur 2.76 3.04 2.83 Meghalaya 3.73 4.57 3.80 Mizoram 2.30 2.89 2.86 Nagaland 3.26 3.77 3.74 Sikkim – 2.75 2.02 Tripura – – 2.22 West Goa 1.90 1.77 1.79 Gujarat 2.99 2.72 2.42 Maharashtra 2.86 2.52 2.11 South Andhra Pradesh 2.59 2.25 1.79 Karnataka 2.85 2.13 2.07 Kerala 2.00 1.96 1.93 Tamil Nadu 2.48 2.19 1.80 India 3.39 2.85 2.68 Source : NFHS, NFHS-2 and NFHS-3.

Total fertility rate (number of children per woman) in the states of India in 1990-1992, 1996-1998 and 2005-2006

54The stage reached in the fertility transition in each state depends on the level of development, but no single dominant factor can be identified. Thus while the poorest states are indeed those where fertility remains highest, the correlation between the mean number of children per woman and the proportion of the population living below the poverty line is less than 0.40, and the same proportion of people living below the poverty line can be associated with sharply contrasted fertility levels. In the mid 2000s, fertility in India was on average 2.68 children per woman and 21.8% of the population lived below the poverty line, yet for similar fertility levels, as in Gujarat and Orissa (2.42 and 2.37 children per woman, respectively) the associated proportions in poverty diverged widely : 12.5% of the population in the former and 39.9% in the latter.

55The difficulty of identifying simple determinants of fertility at the aggregate level of states was clearly illustrated several years ago by a multivariate analysis of the relationship between fertility and women’s education, which also considered the indirect effects of female education via infant mortality and age at marriage (Sharma and Retherford, 1990). The model’s explanatory power was not improved by introducing the level of urbanization. When the residuals were mapped, the deviations from the value explained by the model exhibited geographical contiguity by size, suggesting the influence of regional or local factors (religion, customs, and such like). The complexity of the processes at work was highlighted in a geographical analysis of the fertility transition in southern India by C. Z. Guilmoto and I. S. Rajan (2005), which showed that the explanation needs to include family planning programmes, socioeconomic transformations, and changing reproductive attitudes, and take into account local contexts and the changes affecting them. These authors also viewed the reduction in fertility as the consequence of a social change that diffused gradually between neighbouring populations (Guilmoto and Rajan, 1998 and 2001).

Varying levels of contraceptive practice

56The data on contraception in the countries of South Asia, though variable in both quantity and quality (United Nations, 2005), are adequate to show the diversity of attitudes and behaviour towards contraception (Figure 9). While contraception remains practically non-existent in Afghanistan, where fewer than 5% of women aged 15-49 in unions use any method, contraceptive prevalence in Sri Lanka already stood at the high level of 70% in 2000. The situation in the other countries is also varied : the proportion of women [24] using some form of contraception is 18.8% in Bhutan, 27.6% in Pakistan, 39.3% in Nepal, 48.2% in India and 58.1% in Bangladesh.

Figure 9

Contraceptive prevalence in the countries of South Asia in the 2000s

Contraceptive prevalence in the countries of South Asia in the 2000s

57The use of modern contraception also varies considerably between countries. In Bhutan, barely 19% of women in a union and of childbearing age use any means of contraception [25], but modern methods are used exclusively : 3% are protected by female sterilization, 8% by male sterilization, 2% by the pill, 4% by injection or implant, 1% by IUD, and fewer than 0.5% by use of the condom. By contrast, modern contraception represents only 73% of total contraception in Pakistan and 71% in Sri Lanka. However, the proportions of women using modern contraception are highest in India, Bangladesh and Sri Lanka, which together account for nearly 50% of all the women concerned.

58The condom is not widely used in this region. The highest proportion of users (5.5% of all women of childbearing age in a union) is observed in Pakistan. Use of the IUD is equally limited, with the highest proportion (5.1%) observed in Sri Lanka. The pill is popular only in Bangladesh, where it is used by 26% of all women in a union, representing 45% of women using some method of contraception. In the Maldives, where contraceptive prevalence is 42%, its use is only half as frequent, and Sri Lanka, the third country where this method is in use, has only 6.7% of users. Voluntary sterilization, mainly female, is widely employed by couples in South Asia for limiting family size. Among women of childbearing ages in the Maldives, 10% are protected by female sterilization, and the proportions are 15% in Nepal, 21% in Sri Lanka and 34.2% in India. In South Asia, as elsewhere in the world, there is a clear inverse relationship between fertility and contraception (Figure 10).

Figure 10

Relationship between the total fertility rate and contraceptive prevalence (all methods) in the 2000s

Relationship between the total fertility rate and contraceptive prevalence (all methods) in the 2000s

Sterilization is the main birth control method in India

59Attitudes towards female and male sterilization are extremely diverse in this world region. Sterilization is non-existent in Afghanistan, and is not widely practised in Bhutan, Bangladesh and Pakistan (of these the maximum is in Pakistan, where 7% of women in a union are protected by female sterilization). As mentioned, the proportion of women aged 15-49 relying on sterilization to regulate their fertility is substantially higher elsewhere, but India stands out from the other countries, since over a third of all women are concerned [26]. Male sterilization for birth control purposes, on the other hand, is everywhere at a low level, with the exception of Bhutan where 8% of women in a union are protected by the sterilization of their spouse or partner and 3% by their own sterilization.

60Recourse to sterilization, and essentially female sterilization, has been widespread in India since the mid 1980s (Rajan and Véron, 2006). In 2005-2006, 66% of married women aged 15-49 had been sterilized, and the proportion was 77% among those using modern contraception, whereas only 1% were protected by sterilization of their husband. Trends over the last fifteen years in contraception and in the relative importance of sterilization can be followed using the three NFHS surveys conducted in India (Table 17). Between 1992-1993 and 2005-2006, contraceptive prevalence increased by 15 percentage points, taking to over one half the proportion of women of childbearing age and in a union who now use contraception, against 41% at the start of the 1990s. Over a long period, sterilization and in particular male sterilization was encouraged in India [27], until the excesses committed during the state of emergency (1975-1977) led the central government to issue statements in favour of reversible methods of contraception. In spite of this, female sterilization remains by far the most common means used by Indian couples for controlling their fertility, and even increased by a further 10 percentage points between 1992-1993 and 2005-2006. Official pronouncements intended to promote male rather than female sterilization have had little effect. The proportion of couples relying on male sterilization has remained small and has actually declined over the last fifteen years. All in all, couples judge female sterilization to be the simplest means of controlling their fertility : 77% of sterilized women have chosen this option directly without previously using another method of birth control. Age at sterilization is tending to decrease : the median age of women at sterilization fell from 26.6 in 1992-1993 to 25.5 in 2005-2006. Of 100 sterilized women in the most recent survey, 38 were sterilized at age 20-25 and 35 at age 25-30.

Table 17

Contraceptive methods used in India in the 1990s and 2000s (prevalence in %)

Contraceptive method used 1992-1993 1998-1999 2005-2006 All methods 40.7 48.4 56.3 Modern methods 36.5 42.8 48.5 Female sterilization 27.4 34.2 37.3 Male sterilization 3.5 1.9 1.0 Condom 2.4 3.1 5.2 Pill 1.2 2.1 3.1 IUD 1.9 1.6 1.7 Traditional methods 4.3 5.6 7.8 Population : women aged 15-49 living in union. Sources : NFHS, NFHS-2 and NFHS-3.

Contraceptive methods used in India in the 1990s and 2000s (prevalence in %)

61Country-wide data on sterilization in India conceal large regional disparities. Only 8% of couples are protected by female sterilization in the state of Manipur against 63% in Andhra Pradesh ; and whereas women’s median age at sterilization is 30 in the former, it is a little over 23 in the latter.

A general improvement in life expectancy

62As in the rest of the world, mortality has declined in all countries of the region since 1950 (Figure 11 and Table 18). The region’s two extremes are Afghanistan, where life expectancy at birth is among the lowest in the world (42 years in 2000-2005), and Sri Lanka, where the mean length of life, close to 71 years in 2000-2005, (i.e. nearly 30 years longer) is above the world average. The other countries are in intermediate positions. Although the mortality transitions in these countries differ in some respects, the increases in life expectancy at birth are closely comparable, and in 2000-2005 the populations of Bangladesh, Bhutan, India, the Maldives, Nepal and Pakistan all had lengths of life between 61 and 66 years. These countries are closing the gap with Sri Lanka, where the rate of progress is slowing somewhat, although in 2000-2005, life expectancy there was still five years longer than in the Maldives, the top-ranking intermediate group country.

Figure 11

Life expectancy at birth, 1950-2005 (in years)

Life expectancy at birth, 1950-2005 (in years)

Table 18

Life expectancy since the 1950s, maternal mortality in 2000 and HIV prevalence in 2005

Country Life expectancy (in years) Maternal mortality rate in 2000 (per 100,000 births) HIV prevalence rate at ages 15-49 in 2005 (%) 1950-1955 1960-1965 1970-1975 1980-1985 1990-1995 2000-2005 Afghanistan 28.8 32.0 36.1 39.9 41.7 42.1 1,900 < 0.1 Bangladesh 37.5 41.2 45.3 50.0 56.0 62.0 380 < 0.1 Bhutan 36.1 37.7 41.8 47.9 54.5 63.5 420 < 0.1 India 37.4 43.6 50.7 56.6 60.2 62.9 540 0.9 Maldives 38.9 45.2 51.4 57.1 61.0 65.6 110 – Nepal 36.2 39.4 44.0 49.6 55.7 61.3 740 0.5 Pakistan 43.4 47.7 51.9 56.2 60.8 63.6 500 0.1 Sri Lanka 57.6 62.2 65.0 68.8 70.4 70.8 92 < 0.1 Sources : United Nations (2007a), WHO and UNAIDS.

Life expectancy since the 1950s, maternal mortality in 2000 and HIV prevalence in 2005

63Gender differences in mortality have also evolved substantially over the last fifty years. In the early 1950s, life expectancy at birth was lower for women than for men in every country of the region except Bhutan, as is shown by the index based on the female/male ratio of life expectancies at birth (Figure 12). This result was in direct contradiction with the biological norms that are responsible for men having higher mortality than women at all ages and that, in the absence of sex discrimination, lead to a shorter life expectancy for males than for females. In 1950-1955, this index stood at the particularly low level of 94 in the Maldives and in Pakistan, indicating a large female mortality disadvantage. The male advantage has disappeared in every country over the last fifty years. In 2000-2005, the life expectancies at birth of men and women in Afghanistan and the Maldives were identical. Elsewhere, women are living longer than men. The most favourable relative situation for women is in Sri Lanka, where the ratio is 112 (Figure 12). In the past, the female life expectancy disadvantage was explained in part by maternal mortality, but this was not the only factor involved. Life tables for the years 1945-1947 in Sri Lanka, and for 1970-1972 in India, show an excess female mortality at all ages from birth up to around age 40 (ESCAP, 1982) due to sex inequality in levels of care, attention and education. Discrimination against girls still exists, particularly in certain states of India. It occurs chiefly before birth and, in the countries where the situation in this respect is least favourable, women’s life expectancy is at minimum equal to men’s. Levels of maternal mortality still diverge widely today : the number of maternal deaths per 100,000 births is 92 in Sri Lanka and estimated at 1,900 in Afghanistan (Table 18).

Figure 12

Differential mortality index in 1950-1955 and 2000-2005 (female/male ratio of life expectancies at birth)

Differential mortality index in 1950-1955 and 2000-2005 (female/male ratio of life expectancies at birth)

64Although the numbers of HIV-positive persons can be large because of population size – in India especially [28] – prevalence rates for HIV/AIDS remain relatively low in the region. The maximum is observed in Nepal where the rate among persons aged 15-49 is 0.5% compared with a world average of 0.8% [29]. The prevalence rate of 0.9% initially given for India in 2005 was subsequently revised downwards on the basis of the results from NFHS-3 [30] which found a prevalence rate of 0.28% in the 15-49 age group. The epidemic affects men more than women, and urban more than rural populations (Table 19). It also affects the states of India in different ways, as shown by the regional variations in prevalence (men and women combined): 0.07% in Uttar Pradesh, 0.34% in Tamil Nadu, 0.62 in Maharahtra, 0.69% in Karnataka, 0.97% in Andhra Pradesh and 1.13% in Manipur (prevalence in the other states is 0.13%) [31]. Among women, the prevalence rate is lower for those with no education than for those with at least five years of education (0.27% and 0.49% respectively) but then declines as educational level rises (0.07% for women with at least 12 years in education). Among men, the rate is highest for those with no education (0.5%). It is lower for those with at least five years of education (0.36%) then rises again for those with between five and seven years of education and subsequently falls with length of education (the prevalence rate is 0.16% for men with more than 12 years in education). We note that the highest prevalence rates are observed for women who had sexual intercourse with a high-risk partner in the 12 months before the survey (rate 2.23%) and for those who did not use a condom (rate 2.83%). Prevalence rates for men in the same categories are considerably lower.

Table 19

HIV/AIDS prevalence rate in the adult population (aged 15-49) in India, 2005-2006 (in %)

Women Men Overall Urban areas 0.29 0.41 0.35 Rural areas 0.18 0.32 0.25 Total 0.22 0.36 0.28 Source : NFHS-3 survey.

HIV/AIDS prevalence rate in the adult population (aged 15-49) in India, 2005-2006 (in %)

65For a number of countries in South Asia, the 2005 United Nations report on mortality gives values for male and female life expectancy at birth and at ages 15 and 60 at two separate periods in time (Table 20). The decline in mortality at younger ages accounts for some of the rise in life expectancy at birth but is not the only factor involved since life expectancies at age 15 are also rising. Life expectancies at age 60 are following a more disparate course though the trend is upward.

Table 20

Male and female life expectancy at birth, at age 15 and at age 60 (in years)

Country Years Men Women Years Men Women Afghanistan – – – – – – Bangladesh At birth 1974 45.8 46.6 1994 58.7 58.3 Age 15 1974 46.3 46.1 1994 53.0 51.4 Age 60 1974 14.4 14.0 1994 15.1 15.0 Bhutan – – – – – – India At birth 1961-1970 46.4 44.7 1993-1997 60.4 61.8 Age 15 1961-1971 45.0 44.0 1993-1998 53.1 55.8 Age 60 1961-1972 13.6 13.8 1993-1999 15.5 17.5 Maldives At birth 1982 53.4 49.5 1999 72.1 73.2 Age 15 1982 48.0 43.4 1999 59.2 60.2 Age 60 1982 9.2 8.2 1999 18.8 19.3 Nepal At birth 1981 50.9 48.1 2001 60.1 60.7 Age 15 1981 47.3 46.9 – – Age 60 1981 13.8 14.4 – – Pakistan At birth 1976-1978 59.0 59.2 2001 64.5 66.1 Age 15 1976-1979 56.8 56.3 2001 56.9 58.8 Age 60 1976-1980 19.3 19.3 2001 18.8 20.1 Sri Lanka At birth 1967 64.8 66.9 1991 68.9 73.6 Age 15 1967 55.8 57.7 1991 – – Age 60 1967 17.0 17.8 1991 – – Source : United Nations (2006b).

Male and female life expectancy at birth, at age 15 and at age 60 (in years)

Early-age mortality remains high in most countries

66Infant mortality fell throughout the region between 1960-1965 and 2000-2005 (Table 21 and Figure 13). Sri Lanka and Afghanistan are again in the extreme positions : by the 1960s, infant mortality in Sri Lanka was already much lower than in most countries of South Asia, while in Afghanistan infant mortality was among the highest in the world. Considerable progress has been achieved in the other countries of the region, though infant mortality was still relatively high in the early 2000s : 46‰ in the Maldives, 53‰ in Bhutan, 61‰ in Bangladesh, 63‰ in India, 65‰ in Nepal and 75‰ in Pakistan.

Table 21

Infant mortality since the early 1950s

Infant mortality rate (‰) Change (%) 1952 1972 1992 2002 1952-1972 1972-1992 1992-2002 Afghanistan 275.3 211.6 171.1 168.1 – 23 – 19 – 2 Bangladesh 200.5 148.0 89.0 61.3 – 26 – 40 – 31 Bhutan 184.8 149.2 87.5 52.7 – 19 – 41 – 40 India 165.7 116.8 77.2 62.5 – 30 – 34 – 19 Maldives 185.2 120.6 65.1 45.8 – 35 – 46 – 30 Nepal 210.9 156.1 90.6 64.5 – 26 – 42 – 29 Pakistan 168.6 127.6 87.0 75.4 – 24 – 32 – 13 Sri Lanka 76.6 49.9 17.0 12.4 – 35 – 66 – 27 Source : United Nations (2007a).

Infant mortality since the early 1950s

Figure 13

Infant mortality between 1960-1965 and 2000-2005

Infant mortality between 1960-1965 and 2000-2005

67According to United Nations estimates (2007a), under-five mortality in Afghanistan has not decreased over the last ten years : it was 257‰ in 1990-1995 and 252‰ in 2000-2005. At 14‰ in 2000-2005, under-five mortality in Sri Lanka bears no comparison with that in Afghanistan (Table 22). The next best level of under-five mortality is in the Maldives, where the rate declined considerably in the 1990s but still stood at 59‰ in 2000-2005. Infant and child mortality levels in the other countries were very similar in 1990-1995, with all rates situated between 124‰ and 128‰, but ten years later had become more disparate, ranging from 108‰ in Pakistan to 78‰ in Bhutan.

Table 22

Child mortality, delivery conditions, malnutrition and vaccination

Country Mortality rate (‰) Deliveries attended by skilled health personnel (%) Children malnourished (%) Children vaccinated (%) Neonatal (2004) Below 1 year (2000-2005) 0-5 years (2000-2005) Afghanistan 60 168 252 14 (2003) 53.6 (1997) – Bangladesh 36 61 83 13 (2004) 50.5 (2004) 73.1 (2004) Bhutan 30 53 78 51(2005) 47.7 (1999) – India 39 62 90 48 (2006) 51.0 (1998/99) 42.0 (1999) Maldives 24 46 59 70 (2001) 31.9 (2001) – Nepal 32 64 88 19 (2006) 57.1 (2001) 82.8 (2006) Pakistan 53 75 108 31 (2005) 41.5 (2001) 35.1 (1991) Sri Lanka 8 12 14 97 (2000) 18.4 (2000) 67.3 (1987) (a) Children receiving the full set of vaccinations (BCG, DPT, polio and measles). (b) Children under five with stunted growth. Sources : United Nations, World Health Statistics 2007, DHS surveys and United Nations (2007a).

Child mortality, delivery conditions, malnutrition and vaccination

Child health is closely correlated with mother’s level of education

68Child mortality levels reflect the persistent disparities in child health in South Asia. The proportions of deliveries attended by skilled health personnel, the percentage of malnourished children and the levels of child vaccination coverage provide further proof of this diversity (Table 22).

69The conditions of birth vary widely. In Sri Lanka, 97% of deliveries are attended by skilled health personnel, against 70% in the Maldives, around 50% in Bhutan and India, 14% in Afghanistan and 13% in Bangladesh. The proportion of children vaccinated is also an indicator of health conditions. Though the relevant data are not available for all the countries of the region and some are out of date, in the 2000s the proportion of children vaccinated against the main diseases exceeds 70% in Bangladesh and 80% in Nepal [32].

70Data for India on infant mortality in 2005-2006 highlight the impact of area of residence and mother’s level of education on child health (Table 23). Infant mortality, which has an average value for India of 57‰ in 2005-2006, varies by 20 points depending on whether the area of residence is urban or rural. For children under one, the mortality rate varies by 44 points according to whether the mothers have received no education (70‰) or more than 12 years of education (26‰). In India as elsewhere in the world, the mortality differentials are even larger at ages 1-5. The conditions of delivery are much more favourable in urban areas than in rural areas, since well over 70% of urban births are attended by trained health personnel, compared with less than 40% of rural births. Similarly, the conditions of birth vary considerably with the mother’s educational level, ranging from 26% of deliveries attended by trained personnel for women with no education to 91% for women with at least 12 years of education. The percentage of children receiving the basic vaccinations varies by almost 20 points depending on whether the mother lives in an urban or rural area, and by nearly 50 points between the least and most educated women.

Table 23

Child mortality, delivery conditions and vaccination by area of residence and educational level of mother, India, 2005-2006

Total Area of residence Mother’s level of education (years of shooling) Urban Rural No education Below 5 5-7 8-9 10-11 12+ Infant mortality (‰) 57.0 41.5 62.2 69.7 66.0 49.5 41.5 36.5 25.9 Mortality 1-5 years (‰) 18.4 10.6 21.0 29.9 13.8 11.5 5.6 3.6 3.9 Mortality 0-5 years (‰) 74.3 51.7 82.0 94.7 78.8 60.5 46.9 40.0 29.7 Deliveries attended by trained personnel (%) 46.6 73.5 37.5 26.1 45.0 56.9 67.1 80.3 91.0 Children aged 1 or 2 receiving the main vaccinations (%) 43.5 57.6 38.6 26.1 46.1 51.8 59.7 66.1 75.2 Source : NFHS-3.

Child mortality, delivery conditions and vaccination by area of residence and educational level of mother, India, 2005-2006

71Health inequalities thus remain extremely large in South Asia, whether comparison is between countries or between socioeconomic strata in the population of a single country. India introduced a new health policy in 2002 [33]. Among its clearly stated objectives, based on the principle of equity, is that of reducing the inequalities in access to healthcare associated with urban versus rural residence or with differences in the development level of states or in the economic status of populations. However, it will be some years before its effects become visible.

Young populations

72Median age, a crude indicator of age structure, reveals three sharply contrasting situations inherited from past trends in mortality and fertility (Table 24). A contrast is again observed between Afghanistan, where the fertility transition has hardly started and the population is particularly young (median age 16.4), and Sri Lanka, where the transition is complete and the population is much older (median age 29.5). In the other countries, all of which are engaged in the fertility transition, median ages range from 20 to 24.

Table 24

Indicators of age-sex structure in the countries of South Asia, 2005

Countries Median age (years) Under-15s (%) Over-60s (%) Sex ratio (%) Afghanistan 16.4 47.0 3.7 107.5 Bangladesh 22.2 35.2 5.7 104.9 Bhutan 22.3 33.0 6.9 111.1 India 23.8 33.0 7.5 107.5 Maldives 21.3 34.0 5.6 105.3 Nepal 20.1 39.0 5.8 98.2 Pakistan 20.3 37.2 5.9 106.0 Sri Lanka 29.5 24.2 9.7 97.7 Source : United Nations (2007a).

Indicators of age-sex structure in the countries of South Asia, 2005

73In 2005, all the countries of South Asia with the exception of Sri Lanka had populations with large proportions of young people. Except in Sri Lanka, where the proportion was 24%, the under-15s make up over a third of the population (Table 23). The proportion of young people under 15 is around 40% in Nepal and reaches 47% in Afghanistan.

74Using the proportion – not the absolute number – of people over 60 as the criterion of population ageing, it is clear that the process has made little impact so far in the countries of the region. Only in Sri Lanka is the proportion of over-60s close to 10%, as a consequence of the longstanding fertility decline, whereas it is 7.5% in India and below 7% in the other countries.

75Population projections to 2020 show that Sri Lanka will see a marked ageing of its population in the years ahead, with the proportion of over-60s exceeding 17% by that year (Appendix Table A.11). The next “oldest” country will be India, with 10% of its population over 60. Everywhere else, the over- 60s will still represent less – in some cases much less – than one-tenth of the population. The proportion of persons aged 60 and over is currently very low in Afghanistan (4%) and is unlikely to change between now and 2020.

76The populations in the countries of South Asia are also differentiated by their sex ratios. The largest male surpluses are found in Bhutan, Afghanistan and India ; men are in the minority in Nepal and Sri Lanka, where there were 98 males for 100 females in 2005.

77The large sex imbalance at birth affecting several East and Southeast Asian countries, among them China, is not observed in this region except in India, and then only in the country’s north-west states. We will return later to this sex imbalance that reflects strong discrimination against girl children in these states.

Age distributions reflect the progress of the demographic transition

78The stage of demographic transition reached by the countries of the region is illustrated by their age structures (Figures 14A-14H). The fertility decline in Sri Lanka began many years ago, as shown by the narrower base of the pyramid starting from the 35-39 age group. Despite an “echo” effect [34], cohort size has fallen continuously since 1980-1985. Compared with Sri Lanka, the fertility transition has come later in Bhutan and the Maldives, but cohort size has been falling in both countries for the last twenty and ten years respectively. The base of the population pyramid for Pakistan is starting to contract, while the pyramids for Bangladesh, India and Nepal are very similar, with as yet no major decrease in numbers at young ages. Despite a decline in fertility, the numbers of births are not yet falling, because the population of childbearing age is still large. Afghanistan, finally, presents an age structure characteristic of a country with high fertility and high mortality.

Figure 14

Population pyramids of the countries of South Asia in 2005

Population pyramids of the countries of South Asia in 2005

79Between 2005 and 2020, the proportion of people aged 15-60, i.e. in the working-age population, will increase in all the countries (except Afghanistan). Further increase can be expected even in countries where the proportion of people aged 15-60 was already high in 2005, like Bhutan and the Maldives (60%). This relative increase in the working-age population, before the reduction in the economically inactive young population is cancelled out by the increase in the inactive older population, constitutes the “demographic window”. At this point countries have an opportunity for development, since the dependency ratio is favourable to wealth creation, thanks to the reduced public burden of education costs for the young and of health and pension costs for older people. In Bhutan, people aged 15-60 will represent 67% of the population in 2020. For the countries in a position to benefit, the demographic window represents an opportunity. But the advantage is a potential one, and for it to be realized, the working-age population must be employed in the full sense of the term, with low under-employment or unemployment. Sri Lanka differs from the other countries in that it is already benefiting from the demographic window (the proportion aged 15-60 is currently 66% and will probably descend to 62% by 2020).

Moderate urbanization but strong urban growth

80In South Asia, like elsewhere in the world, the criteria used for classifying populations as “urban” are not all the same. The definition of urban in India can be administrative (localities possessing a municipal charter, etc.) or based on a combination of criteria : number of inhabitants, population density, proportion of men in non-agricultural occupations. In neighbouring Sri Lanka, only populations in “municipal zones and zones with an urban council” are classified as urban (Table 25). In Pakistan, an urban settlement is also defined in uniquely administrative terms. In Nepal, localities needed 5,000 inhabitants to be classified as urban in the 1961 census and 9,000 in subsequent censuses. The criteria for population size and density, continuous built-up area and occupational structure have all changed over time, and since 1999 the definition based on population size, annual income and infrastructure varies between ecological zones according to complex rules (United Nations, 2008) [35].The definition of urban in Bangladesh is similar to that in India but more complex since it also includes public amenities, access to water, educational level, etc.

Table 25

Criteria for defining urban populations in four countries of South Asia

Country Definition of “urban” India Towns and cities : localities possessing a municipal charter, a committee for a municipal zone or designated urban zone or grouped zone (cantonment) or localities with a population of 5,000 or more inhabitants, a population density of 1,000 or more inhabitants per square mile or 400 per sq.km, definite urban characteristics, and with three-quarters of adult males in non-agricultural employment. Maldives Male (capital) Pakistan Localities possessing a municipal charter or a municipal committee and grouped zones (cantonments) Sri Lanka Urban sector : comprising all the municipal zones and zones possessing an urban council. Source : United Nations (2007b).

Criteria for defining urban populations in four countries of South Asia

81The countries of South Asia are still not heavily urbanized (Table 26). In Pakistan, the country with the region’s highest percentage urban in 2005, only 35% of the population lived in towns or cities. The lowest levels of urbanization are observed in Sri Lanka and Nepal, where barely 15% of the inhabitants are urban dwellers. In India, less than 30% of the population today lives in towns or cities, which is three times more than in 1901 and twice the level in 1941, but still a small proportion compared with the world average (50%).

Table 26

Percentage urban, 1950-2005, and projections to 2030

Country 1950 1975 2005 2030 Afghanistan 5.8 13.3 22.9 36.2 Bangladesh 4.3 9.8 25.7 41.0 Bhutan 2.1 7.9 31.0 56.2 India 17.0 21.3 28.7 40.6 Maldives 10.6 17.3 33.9 60.7 Nepal 2.7 4.8 15.8 30.6 Pakistan 17.5 26.3 34.9 49.8 Sri Lanka 15.3 19.5 15.1 21.4 Source : United Nations (2008).

Percentage urban, 1950-2005, and projections to 2030

82Although the proportion of people living in towns and cities is rising at a moderate pace, the total urban population in South Asia has grown sharply over fifty years. It numbered 73.7 million in 1950 and 433.2 million in 2005, representing nearly a six-fold increase (Figure 15). India accounted for much of this urban growth, since of the 433.2 million urban dwellers in South Asia in 2005, three-quarters lived in India. The pace of change in the urban population differs between countries, and in some instances varies greatly between periods within the same country. In Afghanistan, in particular, the urban population grew at an annual rate of 6% in the period 2000-2005, but the rate was negative in the period 1980-1985 [36] then reached 8.5% in the years 1990-1995. For the urban population of Bangladesh, the rate is currently 3.5%, but was in excess of 10% between 1975 and 1980. In Bhutan, the rate of urban population growth since 1950 has fluctuated around an annual average of 5%. The urban growth rate in India climbed from 2.6% in 1950-1955 to 3.8% in 1970-1975 then slowed to its present level of 2.3%. Like Bangladesh, the Maldives experienced a period of rapid urban growth, with a rate of 10% in 1970-1975. Between 1970 and 2000, the urban population in Nepal grew by over 6% a year on average, whereas in Pakistan the rate was between 4% and 4.5% over several decades. Again the pattern for Sri Lanka is singular : the growth rate rose from 2.8% in 1950-1955 to 4.3% in 1965-1970, then fell back to below 1% and is currently close to zero (0.15% in 2000-2005).

Figure 15

The urban population of South Asia and India, 1950-2005

The urban population of South Asia and India, 1950-2005

83According to United Nations forecasts, Pakistan will remain the most urbanized country in the region up to 2030, with nearly one in two inhabitants living in urban areas. Urbanization in Sri Lanka, meanwhile, at slightly over 20%, will still be remarkably low. In Bangladesh and India, 40% of the population will be urban. Although this level might be considered moderate in 2030, it represents a total of 590 million urban-dwellers in India alone.

Five of the world’s thirteen largest cities are in South Asia

84The countries of South Asia are very different in size, and their capital cities likewise. Delhi had 15 million inhabitants in 2005, Katmandu well below one million, and Male, capital of the Maldives, only 89,000 (Table 27).

Table 27

Population change in selected capital and largest cities between 1950 and 2000 and forecasts for 2015

Country Cities Population (in thousands) Ratio Percentage of total population in 2005 Percentage of urban population in 2005 1950 1975 2000 2005 2015 2005/1950 2005/1975 Afghanistan Kabul 171 674 1,963 2,994 4,666 17.5 4.4 10.0 43.8 Bangladesh Dhaka 417 2,173 10,159 12,430 16,842 29.8 5.7 8.8 35.0 Bhutan Thimphu 3 8 60 85 143 India Delhi 1,369 4,426 12,441 15,048 18,604 11.0 3.4 1.4 4.7 Kolkata (Calcutta) 4,513 7,888 13,058 14,277 16,980 3.2 1.8 1.3 4.5 Mumbai (Bombay) 2,857 7,082 16,086 18,196 21,869 6.4 2.6 1.6 5.7 Maldives Male – – – – – – – – – Nepal Kathmandu 104 180 644 815 1,280 7.8 4.5 3.0 19.1 Pakistan Islamabad 36 107 595 736 1,008 20.4 6.9 Karachi 1,047 3,989 10,020 11,608 15,155 11.1 2.9 7.4 21.1 Sri Lanka Colombo 400 572 639 652* 701 1.6 1.1 3.4 22.5 * estimate. Source: United Nations, World Urbanization Prospects: the 2005 Revision.

Population change in selected capital and largest cities between 1950 and 2000 and forecasts for 2015

85The city with the most spectacular growth over the last fifty years is Dhaka, whose population increased thirty-fold in the period 1950-2005. The city became the capital of the newly created Bangladesh in 1971. Between 1975 and 2005, the seven-fold increase in the population of Islamabad was faster than that of Dhaka, where population increased six-fold. The populations of Kabul and Katmandu grew by a factor of 4.4-4.5 over the same period. In fifty years, the population of Delhi has grown more than ten-fold, increasing from 1.4 million in 1950 to 15 million in 2005.

86The demographic weight of the capital cities in their respective countries also varies. Delhi is home to less than 2% of the population of India, whereas 10% of that of Afghanistan lives in Kabul. The inhabitants of the Afghan capital represent 44% of that country’s urban population, whereas the population of Kathmandu represents less than 20% of Nepal’s urban population and that of Delhi less than 5% of India’s.

87The urbanization process is singular in India on account of the population size and its rate of growth in the twentieth century. A long-term comparison with the United States has shown that not only is the percentage urban lower in India but it is not catching up with the American level, even though India has a larger urban population than the United States (Véron, 1987). India already had a number of large cities at the end of the nineteenth century: in 1891, 744,000 people lived in Calcutta, 822,000 in Bombay, 453,000 in Madras and 415,000 in Hyderabad (Davis, 1951), In the 2001 census, India counted 34 urban agglomerations with over one million inhabitants and six with over five million inhabitants: Mumbai (formerly Bombay, 16.4 million), Kolkata (Calcutta, 13.2 million), Delhi (12.9 million), Chennai (formerly Madras, 6.6 million), Hyderabad and Bangalore (each with 5.7 million).

88On a global level, of 21 urban agglomerations with over 10 million inhabitants in 2005, five of them – not all capital cities – were in South Asia: Dhaka, Delhi, Kolkata, Mumbai and Karachi. These five urban agglomerations are among the 13 largest in the world.

Economic and social vulnerability

100Several populations are particularly vulnerable today in economic and social terms. In some regions of India, strong discrimination against girl children is reflected in sex-selective abortion practices. Results from the 2001 Indian census showing a high sex ratio in the young population revealed the extent of discrimination against girl children in the north-west of the country [39]. In the Punjab and in Haryana, which count among India’s most developed states, this discrimination was such that the sex ratio in the population aged 0-6 reached 130 boys for 100 girls in some districts and even higher levels in the district of Fatehgarh Sahib (Nanda and Véron, 2004). Women’s educational level is relatively high in the Punjab (the female literacy rate was 64% in 2001), yet female foetuses are nonetheless aborted in large numbers, the result of a traditional boy preference that may have been rekindled by falling birth rates [40]. In recent years, the government has made efforts to stamp out the practice of sex-selective abortion via information campaigns and sanctions against practitioners who tell couples the sex of an unborn child, but without much apparent success. For India as a whole, the sex ratio of the 0-6 age group was 108.9 in the 2005-2006 NFHS, against 107.9 in the 2001 census. The sex ratio has not changed in urban areas but has risen in rural areas.

101Vulnerability also takes other forms [41]. Vulnerable populations include child workers, unemployed adults, and those, particularly at older ages, without access to a system of social protection. Although the demographic weight of older people remains limited in South Asia, their number is rising and, in India for example, the question of population ageing is an emerging concern (Bose and Shankardass, 2004). The country today has more than 80 million people over age 60 and by 2016 is likely to have more than 110 million. Since half of all men over age 60, and more than 70% of women, are economically dependent on other people, their economic security is set to become a crucial issue.

102Another form of vulnerability is linked to the problem of urban housing among the poorest populations as evidenced by the spontaneous settlements and shanty towns that spring up on city outskirts. UN-Habitat estimates that over 230 million people lived in shanty towns in South Asia in 2001 [42]. According to the same source, shanty town-dwellers numbered 30 million in Bangladesh, 36 million in Pakistan and 158 million in India. In addition to economic and social vulnerability, the populations may also face ecological vulnerability.

Environmental vulnerability

103Living conditions for a large proportion of the population of Bangladesh in the Ganges-Brahmaputra delta are particularly hazardous. High population densities mean that each episode of flooding produces large numbers of victims. The history of natural disasters in Bangladesh over the last two hundred years reveals the full extent of the country’s exposure to ecological hazards (Table 29). In late 2007, the agricultural sector was again badly hit by a tropical cyclone, with losses to nearly 7 million people.

Table 29

Major disasters in Bangladesh over two centuries

Years Event Losses 1769-1776 Great famine of Bengal Nearly one-third reduction in the Bengal population, though impact was lighter in West Bengal 1784-1788 Floods and famine. Brahmaputra River changed its course Unknown 1873-1874 Famine Unknown 1876 Bakerganj cyclone and tidal wave Around 400,000 deaths 1884-1885 Famine Unknown 1897 Chittagong cyclone Around 175,000 deaths 1918-1919 Spanish influenza Around 400,000 deaths 1943 Bengal famine Between 2 and 2.5 million deaths 1947 Partition of India Unknown. Total deaths in partition numbered 1 million, but most occurred in the West 1970 Cyclone and tidal wave Between 200,000 and 500,000 deaths 1971 War of Independence Around 500,000 deaths 1974 Famine Official death toll 30,000, but some estimates are much higher (including reference to 500,000 deaths with 80,000 for the Rangpur district alone). Source: W. Brian Arthur and Geoffrey McNicoll, "An analytical survey of population and development in Bangladesh", Population and Development Review, 4(1), March 1978, p. 29, cited by Escap (1981).

Major disasters in Bangladesh over two centuries

104In other countries of the region, such as India, the Maldives or Sri Lanka, substantial proportions of the population are severely exposed to rising water levels. The earlier period of rapid population growth in these countries brought a large increase in population densities. In India, average population density rose from 77 inhabitants per sq.km in 1901 to 324 in 2001; it currently stands at over 800 inhabitants per sq.km in Kerala and 900 in West Bengal. The resulting pressure on land has led to increased settlement in coastal zones, which are barely above sea level. The consequences of the 2004 tsunami were particularly disastrous in Sri Lanka, in the Indian states of Tamil Nadu and Kerala, and in the Maldives, all of which had large populations living at sea level. In India, it left 11,000 persons dead, 5,600 missing and around 7,000 injured. The worst affected Indian state, Tamil Nadu, alone counted 8,000 dead [43]. In Sri Lanka, the tsunami caused 40,000 deaths and displaced 2.5 million persons. Rising water levels due to climate change threaten a growing number of people in Bangladesh, India, the Maldives and Sri Lanka.