Introduction

The demographic dividend has been the subject matter of immense interest across countries, among both scholars and policymakers in recent decades. It is also known as the demographic window of opportunities, implying that considerable opportunities exist for nations due to the favourable changes in the age structure brought about by fertility decline. The demographic dividend is the result of an increase in the share of the working-age population and a decline in the combined share of the old- and young-age dependant population. The swelling of the working-age population may cause a rise in the supply of labour force in the market, a decline in the child population may cause a shift in demand for household resources from investment in children to greater capital investment, and fertility decline may allow a rise in female workforce participation (Bloom et al., 2009).

The debate on the change in the population structure and economic growth has been a well-researched and discussed issue that was initiated by Thomas Robert Malthus. Later, Coale and Hoover (1958), in a seminal work, estimated the economic benefits of fertility decline, taking India also as an example. Similarly, Kuznets (1967) found that a population increase negatively affects the economic development of a country. On the contrary, Kelley (1988) observed that there is no universal association between population increase and growth in per capita income and savings rates. On the other hand, Lutz et al. (2019), using the panel data of 165 countries, documented that the human capital as measured by educational attainment causes a change in the age structure and economic development. Despite these mixed findings on the relationship between population and development, a large number of studies established that the change in the age structure itself has inevitable economic benefits (Lee and Mason, 2006; Bloom et al., 2010; James, 2008; Joe, Kumar, and Rajpal, 2018; Mason, Lee, and Lee, 2010).

Even while the demographic dividend potential is well recognized in India, there are many pessimistic views expressed on the ability of the country to take advantage of demographic changes due to several institutional constraints. The primary argument against expecting a substantial demographic dividend in India rests on the poor skill levels in the country and the lack of job opportunities. Of these, the lack of significant increase in female labour-force participation has attracted wide attention in recent times (Desai, 2010; Klasen and Pieters, 2012).

There is an increasing attention on India's population and its changing age structure in recent times with its long-term implications for every facets of life. Considering the sheer volume of the country's population size, the demographic changes in India will have a unique role in altering the global population scenarios. With the global community and national governments being deeply committed and enthusiastically engaged in the achievement of Sustainable Developments Goals (SDGs), India's demographic and health changes become critically significant.

Undoubtedly, the major demographic processes in India are experiencing extraordinary changes: fertility reaching at replacement level, life expectancy climbing up significantly, rapid changes in the health and epidemiological transitions, and a faster urbanization with new flows of migration. Along with structural changes, India is also witnessing a dramatic rise in its middle class and its fast-changing aspirations. All these ongoing transitions have considerable socio-economic and political repercussions. In this context, India Population Report would be an important resource for researchers and policymakers to understand (a) the contemporary scenarios of the Indian population, (b) the different challenges posed by geographically and socio-economically heterogeneous fertility, mortality, and health transitions, and migration flows, and (c) the opportunities from the point of view of the well-being of all.

The International Institute for Population Sciences (IIPS), Mumbai, is the leading training and research institution for Demography and Population Studies in Asia. Over the years, IIPS has undertaken landmark surveys and significant research on population, health, fertility, mortality, nutrition, ageing, and migration, and on women and children. Given this background, it was felt that IIPS should bring out a population report on India at regular intervals, deliberating current scenarios and future implications. This volume is the first attempt in that series of publications contemplated.

The volume is an outcome of the recent studies undertaken by a large number of scholars with deep understanding of India's demographic and health sectors. By making use of the latest available scientific evidences, the chapters in the volume illustrate the implications ahead for India in meeting the inevitable population and health challenges in the coming decades.

We are grateful to all the authors for their interest and contributions. We also acknowledge the meticulous efforts of Cambridge University Press, particularly Anwesha Rana and Priyanka Das, for their help in bringing out this volume.

Demographic change has been one of the salient and defining social revolutions taking place in India since the last few decades. The key demographic processes are experiencing extraordinary changes: Women's fertility has plunged rapidly and life expectancy has climbed to new highs. The transition from a period of enormous concern on population explosion during the early part of the second half of the last century to a phase of discussion on the demographic dividend and population ageing has not been smooth but appreciable to any standard. The transition has touched many aspects of individual, household, and community lives in India. The country has already reached a desirable target of replacement-level fertility as per available data and will be entering into an era of slow or very slow population growth in the coming decades. Demographic changes create their own ripples in any society, let alone India where the transition is unconventionally defying many theories and arguments. Therefore, it is important to have a careful look into the demographic changes in India and their various facets.

Considering the sheer volume of the population size in India, the demographic changes in the country have a unique role in altering the global population scenarios. When the global community and the national governments are committed to the Sustainable Developments Goals (SDGs), India is critically significant in altering the global figures. Despite accelerated fertility decline in the country, the available population momentum will drive population growth for some more time. According to the United Nations’ World Population Prospects (2022 Revision), India is expected to overtake China as the world's most largest populous country in 2023. In this context, this book would be an important asset for researchers and policymakers to understand (a) the contemporary conditions of the Indian population, (b) the different challenges posed by geographically and socio-economically heterogeneous fertility, mortality, and health transitions and migration flows, and (c) the opportunities from the point of view of the well-being of all. The rest of the chapter is organized in three parts: The first part introduces the key components of population change (fertility, mortality, and migration); the second part discusses the consequences of population change; and the third part summarizes the contents discussed in the various chapters of the book.

Introduction

Mortality is the first key component among three demographic processes – that is, mortality, fertility, and migration – that contribute to the population change of a country. The worldwide decline in death rates recorded in the 1960s is labelled as ‘mortality transition’ by demographers to signify the path from high and fluctuating mortality to low and stable mortality. The transition in mortality implies enhancements in the quality of life through developments in healthcare, and, accordingly, a lot of importance has been given to it. Moreover, understanding the shift in mortality, age-specific morbidity, and age–cause-specific mortality is essential for drafting changes in public healthcare policy, allocation of healthcare finances, and human resources, thereby averting premature deaths (Anderson and Silver, 1997; Mathers et al., 2005; Désesquelles et al., 2012; Jha, 2012; Dandona et al., 2017; Nkengasong et al., 2020).

Globally, non-communicable diseases (NCDs) account for 7 out of 10 deaths, making them the leading cause of ill health and mortality (World Health Organization [WHO], 2018). In absolute numbers, NCDs cause higher premature mortality in low- and middle-income countries (LMICs) compared to their high-income counterparts. In 2016, 31.5 million NCD deaths occurred in the LMICs – that is, almost three-quarters of global NCD deaths. Since the 1990s, mortality from communicable diseases (CDs) has declined relative to mortality due to NCDs (WHO, 2018). Nevertheless, communicable, maternal, perinatal, and nutritional conditions still account for 38 per cent of all deaths in the LMICs from 2000 to 2015 (WHO, 2016). Thus, most LMICs, including India, are experiencing a dual burden of diseases with higher morbidity and mortality from NCDs and also complementarily a high prevalence of different infectious and parasitic diseases (Agyei-Mensah and Aikins, 2010; Barquera, Pedroza-Tobias, and Medina, 2016).

The inadequate health-management system and the lack of parallel socio-economic changes across all population groups are mainly attributed to this high burden of infectious and parasitic diseases among child and young populations (Defo, 2014). Meanwhile, the lifestyle and behavioural transitions since the 1990s in the LMICs have triggered the rapid increase in NCD-induced morbidity and mortality (Boutayeb and Boutayeb, 2005; Habib and Saha, 2010; Morfeld and Erren, 2019; Malta et al., 2020; Coates et al., 2020). Achieving Sustainable Development Goal (SDG)-3 in the LMICs prerequisites reducing avoidable mortality due to both NCDs and CDs (Norheim et al., 2015; Bennett et al., 2018; Fullman et al., 2017).