First and foremost, the need of this study arises out of the fact that the discourse of demographic convergence is ever receiving a greater attention in other parts of the world, whereas in India, the discourse on demographic convergence is barely given any attention.
Demographic convergence, low fertility and their implications are typically discussed in the context of Western Europe and other Northern countries of the world. However, over the last two decades, these trends have begun to be replaced by the high fertility and mortality in developing country populations too. As such, demographic convergence is a world-wide phenomenon, but developed and developing countries are likely to experience the effects of these trends differently. Though, the rapid fall in fertility carries concerns over distribution of resources, both in developed and developing countries, the
23 ramifications are much more severe in developing countries because they are compounded by the challenges of socioeconomic development and inequality.
In India, during the past 50 years, there has been a gradual improvement in life expectancy at birth. There has been a general decrease in mortality in India leading to significant gains in life expectancy, both at the country and state level over the last three decades (Dyson et al., 2004; Goli and Arokiasamy, 2013). Similarly, there is also an accelerating decline in fertility (James and Nair, 2005; Arokiasamy et al., 2013). However, an important issue emerging out of the national progress in demographic outcomes is, whether progress across the states is converging or not? However, there are virtually no studies in Indian context precisely answering this question.
Second, though the progress in health outcomes in India appears to be positive across all the states and socioeconomic groups, yet convergence in such progress yet to be examined. The population and health in India are improving with divergent pattern across states, rural-urban and socioeconomic groups. Therefore, the future challenges for health policies at this junction are to reduce inequality, not just to lengthen the life. There are studies on health inequality, but such studies have not moved beyond quantifying health inequalities to its socioeconomic determinants. Until now, we do not have a logical and theoretical framework to assess, monitor and review the health inequalities alongside the demographic and health progress. Although India is experiencing significant socioeconomic, demographic and health transition, there are no evidence about socioeconomic, demographic and health convergence. To our knowledge, there is no major study that has attempted to assess the patterns, volume, and speed of demographic convergence and its linkage with health inequalities in India. With ambiguity in extant literature in India, we cannot predict with confidence whether SES differentials in health, especially in child health will diminish or grow with the convergence in fertility decline.
Thus, more empirical evidences on the convergence pattern of SES differential in demographic status, especially in a different social context, can help us to evaluate the merit and applicability of the convergence or divergence measures in population parameters. Therefore, there is a need to look far beyond customary demographic statistics to measure and monitor the progress in demographic imbalance between different states, rural-urban and socioeconomic groups.
24 Thirdly, demographic convergence and rising health inequalities and causal relationships are critical to understand the future direction and progress in population and health. This necessitates positioning of the convergence framework in terms of demographic indicators and its linkage with health inequalities. Thus, this study aims to examine the health inequalities in the context of ongoing demographic change and demographic convergence.
This also attempts to address the speculative ideas prevailing over the hypotheses that
“demographic change and demographic convergence reflects convergence in health status too” or does health inequalities are swimming against the tide of economic growth and demographic progress until post-transition homogeneity appears? The assessment of how different geographic units are moving and converging demographically is important for the projection and prediction of future population and health. Studying demographic convergence can further inform our understanding of socioeconomic, demographic and health progress in terms of equity, since demographics are affected by causality dilemma of the socioeconomic status.
Finally, there is a need for a generalized framework for the study of ‘life cycle of inequality transition’. An important weakness in the current demographic literature in India is the lack of a generalized and unifying framework that is relevant to study the demographic inequality similar to other types of inequality, such as income, education and health. The current demographic scenario, in conjunction with increasing demands for accountability, requires intensified efforts to innovate and bridge the gap between diverse disciplinary theories to ensure that demographic methods and tools to take advantage of the other social science and provide valid, reliable and comparable measurements for wider implementation. What has been missing from the Indian health calendar is a crosscutting population and health measurement tools that unites the different disciplines that have something to contribute to an enhanced capacity of Indian population and health measurement and evaluation. Therefore, the important rationale of this study is to provide the cutting-edge summary measures in terms of convergence tools to assess and monitor the socioeconomic, demographic and health progress, and inequalities in India by using available data. Convergence measures act as a catalyst for population health measurement and evaluation that bridge the gaps in policy formulation, monitoring, reviews and remedies. Therefore, this study attempts to fill critical gaps, said above.
25 1.4. Research questions
The following critical research questions are addressed in this study.
1. What are the critical change-points in demographic trends in India?
2. Are the trends in socioeconomic, demographic and health indicators across the states in India heading to converge?
3. Do the improvements in average SES, demographic and health status reduce inequalities in the same indicators?
4. Do the improvements in the average SES, demographic and health status reduce health inequalities?
5. Has demographic convergence reduced inequalities in child health status?
6. What is the magnitude of a gap that needs to be reduced to bring Indian states to the line of equity and to the line of highest achievement in demographic and health status?
1.5. Objectives
The major objectives of the study are
1. To assess the process of demographic transition in India using change-point analyses 2. To measure socioeconomic convergence across the major states of India
3. To measure fertility convergence across major states, rural-urban and socioeconomic stratum
4. To measure mortality convergence across the major states, rural-urban and socioeconomic stratum
5. To assess the convergence in child health status across the major states, rural-urban and socioeconomic stratum
6. To examine the linkage of demographic transition, convergence and inequalities in child health status
7. To understand the prospects of convergence to the line of equity and the line of highest achievement in India and major states
1.6. Hypotheses
Following null hypotheses are formulated to address in this study 1. There are no critical changes in demographic trends in India 2. There is no convergence in socioeconomic progress
3. There is no convergence in demographic (fertility and mortality) progress
26 4. There is no convergence in child health progress
5. There is no relation between improvements in average socioeconomic, demographic and children’s health status and inequalities
6. There is no relation between demographic convergence and inequalities in children’s health status
7. There are no avoidable demographic and health disparities in India
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