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| ORIGINAL ARTICLE |
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| Year : 2022 | Volume
: 7
| Issue : 2 | Page : 262-265 |
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Decreasing fertility trend in Sikkim: An area of concern
Bal Krishna Chauhan, Dechenla Tshering Bhutia
Department of Community Medicine, Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim, India
| Date of Submission | 10-Jan-2022 |
| Date of Acceptance | 02-Mar-2022 |
| Date of Web Publication | 09-Sep-2022 |
Correspondence Address:
Bal Krishna Chauhan
Department of Community Medicine, Sikkim Manipal Institute of Medical Sciences, 5th Mile Tadong, Gangtok, Sikkim
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/bjhs.bjhs_5_22
AIMS: Factors determining low fertility in Sikkim, India.
PRIMARY OBJECTIVE: The primary objective was to determine the factors for the low fertility in Sikkim.
SECONDARY OBJECTIVE: The secondary objective was to find out the prevalence of contraceptive use and its types in Sikkim.
SUBJECTS AND METHODS: Study Setting: The study was conducted in the State of Sikkim. Study Period: The study period was 1 year (from February 2020 to January 2021). Study Population: The study population was female counterpart of the eligible couple. An eligible couple refers to a currently couple wherein the wife is in the reproductive age, which is between 15 and 49 years. Inclusion Criteria: Inclusion criteria were female counterparts of the eligible couple who consent to participate in the study. Exclusion Criteria: Exclusion criteria were male counterparts of the eligible couple. Study Tool: Structured pre-tested questionnaire was used to take the interview of the participants. Statistical Analysis Used: SPSS version 25 was used for statistical analysis.
RESULTS: It was seen that having two or more children was higher for mothers who had married below 30 years than after 30 years with 14.9% and 6.9%, respectively (P = 0.03) and maximum mothers belonged to 30–34 years age group. The perception of the family size of the mother was that three-fourth (76.1%) responded to having two children, whereas 10.7% perceived one child to be sufficient and 13.2% mentioned having three or more. The overall contraceptive prevalence rate was found to be 73.8%.
CONCLUSIONS: Causes for low fertility rate are multifactorial; some important ones are the perception and practice of concise and small family size and high contraceptive prevalence rate.
Keywords: Contraceptive, eligible couple, NFHS, total fertility rate
How to cite this article:
Chauhan BK, Bhutia DT. Decreasing fertility trend in Sikkim: An area of concern. BLDE Univ J Health Sci 2022;7:262-5 |
Demography is the scientific study of the human population. It deals with mainly five demographic processes, i.e., fertility, mortality, marriage, migration, and social mobility. These five processes are always at work to determine the size, composition, and distribution of the population. Among these, fertility is one of the important processes that keep the population momentum and future posterity.
Total fertility rate (TFR) is an important demographic indicator and is defined as “the average number of children a woman would have if she were to pass through her reproductive years bearing children at the same rates as the women now in each age group.”
The TFR is the most widely used fertility measure than others for two main reasons: first, it is unaffected by differences or changes in age-sex composition, and second, it provides easy to understand hypothetical completed fertility.[1] TFR of 2.1 is considered as the replacement value.
Fertility transition is when there is a long-term decline in the number of children from four or more per woman to two or fewer.[2] It is a known fact that the sustained low fertility will have an impact on the composition of the population in which we will be having less young and more aged demography. This will shift child dependency to old-age dependency, which is connoted as a demographic burden by the demographers.[3] The more immediate impacts of low fertility will be the shrinking labor forces, and the long-term effect will be the change in ethnicity due to immigration and subsequent skewing of the population where the original ethnicities are pushed to the minority.[4] Apart from this, very low fertility will transform a wide range of social and behavioral relationships, and the increasing number of fewer siblings and childlessness will diminish the family networks that provide social, economical, and psychological support.
TFR in Sikkim, a tiny Himalayan State of India, declined by 129%, i.e., 2.75 in 1998–1999 and 1.2 in 2015–2016(National Family Health Survey-4).[5] The recent National Family Health Survey-5 reports have shown that the overall fertility rate of the state has further gone down to 1.1.
The study on low fertility has not been conducted in the state so far, and this study will be able to throw some light on the possible factors for low fertility in Sikkim.
| Subjects and Methods | |  |
Study setting
The study is conducted in the State of Sikkim. The population of Sikkim as per the census 2011 is 6.11 lakhs and is mostly concentrated in the East District, with about close to 3 lakhs people living in this district.
Study period
The study period was 1 year (from February 2020 to January 2021).
Study design
This was a cross-sectional type of descriptive epidemiological study.
Study population
The study population was female counterpart of the eligible couple. An eligible couple refers to a currently couple wherein the wife is in the reproductive age, which is between 15 and 49 years. It is estimated that there are at least 150‒180 eligible couples per thousand populations in India.[3]
Inclusion criteria
Inclusion criteria were female counterparts of the eligible couple who consent to participate in the study.
Exclusion criteria
Exclusion criteria were male counterparts of the eligible couple.
Study tool
A structured pretested questionnaire was used to take the interview of the participants. The questionnaire contained three parts: the first part contained the details of the participant, the second part contained questions on contraception, and the third on fertility.
Sample size – 561
Considering the general marital fertility rate of Sikkim, which is 97/1000 married women in the reproductive age group as per the census of India 2011 data for Sikkim, and applying the formula of 4 pq/L2 with 2.5% absolute error, the sample size was calculated as 561 which are proportionately distributed using probability proportionate to size method between one urban and one rural area of one randomly selected district in Sikkim.
Sampling strategy
Multistage simple random sampling by lottery method was done. Both urban and rural areas were taken from one randomly selected district of Sikkim after selecting the subdivision, blocks, and villages/towns falling under it.
Statistical analysis
The collected data were entered in an Excel spreadsheet, and analysis was carried out using IBM Corp. Released 2017. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp.
| Results | | |
In sociodemographic profile [Table 1] of the participating women, the maximum belonged to 30–34 years age group, and majority of them followed the Hindu religion, 55.8% (n = 313), followed by Buddhist, 26.4% (n = 148). Majority of the women had acquired education up to high school and 32.3% were working.
It was seen that number of children more than two was higher for mothers who had married below 30 years than after 30 years with 14.9% and 6.9%, respectively (P = 0.03).
Mother's educational status was significantly associated with less number of children as compared to illiterate with 7% and 36.7% (P < 0.000), no difference was seen in the education level for having single or two children [Table 2].
The multivariable regression showed education and domicile status of the women to be statistically significant; however, none of the factors were strongly associated with the childbearing of two or less children [Table 3]. | Table 3: Multiple logistic regressions for factors determining childbearing
Click here to view |
The perception of the family size of the mother was that three-fourth (76.1%) responded to having two children, whereas the rest perceived one (10.7%) as sufficient and 13.2% mentioned having three or more [Figure 1]. About 77% of the total eligible couples did not have more than two children. The contraceptive prevalence rate was found to be 73.8%.
| Discussion | | |
The age of marriage and age at first childbirth was 21.5 years and 20.6 years and has not skewed toward 30 years or above. The perception of the ideal family size of the majority of the participants was two or fewer children. The presence of primary infertility was not that high, but the presence of secondary infertility was slightly higher than the national average. It has been long observed that educated women tend to have less number of children in general, as Makoto[6] observes that higher education attainment by the women and availing wide job prospects will lead to reduced fertility. When the relationship between the level of education with the number of childbearing is seen, the graduates and above-educated women tend to have less number of three or more children than the illiterates. Likewise, a similar difference was observed for a single child. However, a not significant difference was observed for mothers having two children.
With respect to the working status, it was seen that the single childbearing was slightly more in working than nonworking women and three or more childbearing was more for nonworking women than the working women. There was not much difference in terms of bearing two children among both the groups. The family belonging to a lower socioeconomic class had more than three or more children than the higher socioeconomic group.
The contraceptive prevalence rate was higher than the national average and slightly more than the findings of the NFHS V.[7]
The limitation of the study is that the respondents were the female counterpart of the eligible couple, and the husband was not interviewed. As family planning is mostly a collective decision and sometimes the husband takes the major decision, their nonparticipation might not give the full opinion of the family planning practices of the couple. However, this will be an advantage that the woman would be able to give her opinion independently. The factors leading to low fertility are varied. The other factors not taken into consideration in this study are – marriage rates, unmarried rates, abortion rate, widow remarriage rates, etc. These all have a significant bearing on overall fertility.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | |
| 2. | Mason KO. Explaining fertility transitions. Demography 1997;34:443-54.  |
| 3. | Parks KP. Text Book of Preventive & Social Medicine. 25/E. Jabalpur: Banarsidas Bhanot Publishers; 2019. |
| 4. | Coleman D. Immigration and ethnic change in low-fertility countries: A third demographic transition. Popul Dev Rev 2006;32:401-46. |
| 5. | |
| 6. | Atoh M. Family changes in the context of lowest-low fertility: The case of Japan. Int J Jpn Sociol 2008;17:14-29. |
| 7. | |
[Figure 1]
[Table 1], [Table 2], [Table 3]
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