Prem P. Talwar

I INTRODUCTION

Urbanization is a natural consequence of the process of industrialization and rapid population growth. While the latter acts as a push factor for sending people out to ease pressure on land, the former factor pulls them by providing job opportunities and better infrastructure and service facilities in cities. This type of movement has been found to be good for the development of both the sending and receiving areas provided a balance is maintained between the number of people and the resources available in the area.

It is unfortunate that a movement to urban areas these days has not kept that balance; people tend to concentrate in large cities, by-passing small and medium-sized cities. Such uneven spread of the urban population has over-strained resources of large cities and under-developed those of the small and medium-sized cities affecting the quality of life in cities of all size categories.

This pattern of urbanization has caused concern among planners who have started questioning its role in the development of the country. They are faced with the acute problem of containing over-urbanization of the large cities on the one hand, and exploiting developmental potential of small and medium-sized cities on the other. They would also like to make sure that the smaller cities do not follow the same cycle of growth. They are keen to have an integrated and balanced urban hierarchy that emphasizes complementarity among small towns, medium-sized cities and large cities. Such balanced growth of urbanization is necessary for harnessing its full developmental potential.

The United Nations has played a significant role by focusing attention on the issue of urbanization. The World Population Conference in 1974 and several seminars have brought countries together to share experiences of their efforts to influence urbanization processes in order to improve the quality of life of people in the receiving cities and for that matter in the hinterland from which the migrants move out (United Nations, 1975; UNFPA, 1986a; UNFPA, 1986b).

The dimension of the problem of urbanization is large. It ranges from neglect of the areas from which the exodus takes place, to the attainment of more balanced urban settlements covering the aspect of counteracting the excess migration to the metropolitan areas. This paper will address itself to only one issue, namely, growth of medium-sized cities and how they can bring order to the process of urbanization. The development of such settlements could play a positive role in the development of rural areas, of small cities, and of large agglomerations. It will help ward off the formation of primate cities (and its consequent problems) and bring balance in the growth of cities of various sizes. They can help distribute public services and facilities more evenly across the country and spread the benefits of development to larger numbers. If medium-sized cities are developed and are attractive enough, the rural migrants will settle in cities close to their place of origin rather then traverse long distances to reach large cities. This type of settlement pattern will bring close interaction between rural and urban areas, which is a necessary condition for better living. The migrants will keep regular contact with their relatives and friends and receive support and in turn, give, them information on urban and modern living during visits to their homes. The growth of such cities could be a counter-magnet to the explosive of primate cities. In other words, policies in favor of the growth of medium- sized cities can bring order to the spatial distribution of population and thus uniformity in social and economic development of the country. There is therefore need to focus on the growth of medium-sized cities. This Conference of UNFPA is a very timely effort for balanced and real development.

What constitutes a medium-sized city? There is no one opinion in this regard. The classification of cities in a country is dependent on its total size and the proportion of its population living in the urban areas. This is one main reason why the classification of cities in size categories is different for different countries. Nor is there a real need for its standardization. For this paper we define medium-sized cities as those with a population between one to two million in and around 1980.

This paper attempts to study the population dynamics of medium-sized cities, covering both growth patterns and the profile of people living in these cities. The purpose is to understand them in order to bring about their planned development and reap the maximum benefit in the overall development of the country. This paper will have five sections. After a general introductory section it discusses the role of medium-sized cities in the overall development. The third section deals with population dynamics in those cities covering their pattern of growth. The Indian Census of 1981 will form the major source of data for such analysis. The next section discusses the profile of population living in these cities. The experiences of their countries and some data from India form the material for this section. The last section covers a series of recommendations for balanced urban development, particularly that of the medium-sized cities.

II ROLE OF MEDIUM-SIZED CITIES

An optimum development of medium-sized cities could be important for the overall social and economic development of a country. Not only can such cities serve as an outlet for pressures on land in rural areas but can act as a buffer for the rush to large metropolitan areas. They link rural areas with urban and thus strengthen the supportive role of the rural-urban nexus. By staying in medium-sized cities, rural migrants can be close to their original place of residence, thus keeping constant contact with rural areas. They can get moral strength from their friends and relatives in rural areas and in return, can share the good values of urban and modern living with their fellow beings in villages. There is no need for them to go to far off large cities and lose their identity and create problems related to the quality of life for themselves and for the natural residents of these large cities. Therefore all efforts should be made to harness the full potential of the medium-sized cities by formulating strategies to develop them in a planned fashion. This section will discuss the possible role of medium-sized cities in balanced urban growth and overall economic development.

The beneficial role of medium-sized cities can be grouped into the following four types:

(a) Linking rural hinterland with cities;

(b) Permitting efficient use of resources available in these cities for development;

(c) Bringing about equitable distribution of facilities and services; and

(d) Reducing problems related with heavy concentration of the population in large urban agglomerations

Linking Rural Hinterlands with Cities

A rapidly growing population has a tendency to push people out in search of livelihood and better opportunities. With current patterns of urbanization, where only a few primate cities have the pulling force, the distance between the original place of living of the migrant and his destination becomes too large. Settling in a far off place tends to break his links with the area where his roots are and he loses his identity. His ties get severed and ultimately he is unable to get the moral support of his relatives and friends. Ways of living in large cities can be new and shocking, he can get isolated and feel lost in the new environment. The security of social and cultural values of his original place is shattered by a mixed and unknown value system. He is lost in the mixed crowd of large cities and makes every attempt to find his identity by picking up any straw in the unknown. He is very vulnerable at this stage of life and falls easy prey to bad influences. The inevitable consequence of this period of uncertainty is crime and a deteriorating law and order situation, a characteristic of heavy concentration of population in large urban agglomerations.

The development of medium-sized cities (and small-sized cities) will keep most of the migrants close to their place of origin where their roots are deep and they can feel safe and secure. They can defend themselves against bad influences. They find strong support and are therefore prepared to take on new challenges. Such an environment can bring out the best in the migrants . They also become pioneers and messengers for friends and relatives in rural areas by carrying back the news of urban and modern living. The rural-urban communication thus becomes inter-personal and strong and modern ideas reach the remote rural areas of the country. This climate is most suited for the best social and economic development of the country. Therefore it is beneficial to keep migrants close to their place of origin. This can be achieved by developing medium-sized cities. It is possible only if these cities have adequate infrastructure and service support so as to attract migrants. Necessary policy measures need to be formulated to achieve these needs.

Permitting Efficient Use of Resources

Every place has its own resources which need to be harnessed. This is possible only if systematic efforts are made to exploit them. The current metropolitan areas were once in a dormant situation, before the first initiatives were taken to develop their resources. Efforts of the government and individuals helped in the development of an attractive infrastructure and services, and the area grew industrially. This advantageous position, in turn, attracted more investment, and the economic development of the area became rapid. It is this initiative which gets the ball of development rolling. It is unfortunate that it has happened in the case of only a few cities. Several others with potential have been neglected and ignored. There is a need to bring medium-sized cities into the cycle of development. Planned and conscious efforts, effective policies, and new strategies are needed. Initial efforts may be greater and the returns less, but the long term impact on development of such planned activities is large. The government should formulate policies to encourage the developmental activities in medium-sized cities in order to reap their advantage for the overall development. This will expedite the process of development of the country without over-straining resources of a few primate cities.

Bringing Equitable Distribution of Facilities and Services.

The present pattern of development is sporadic and not comprehensive. Some areas are over-developed with strained infrastructure and services and others are under-developed and even neglected. All economic activities are concentrated in a few pockets leaving others backward. This type of development has a dual effect: (i) every entrepreneur wishes to invest in only a few selected primate cities, which not only further strains the existing infrastructure and brings low returns for investment, but leaves resources of other areas unharnessed, and (ii) economic activities undertaken in a few areas cannot meet the needs of a rapidly growing population and leads to shortages and price rises. These ill-effects of the rapid growth of primate cities have to be contained by developing other areas and shifting efforts. Several efforts have been made in different countries and much more needs to be done. Development efforts have to be spread in medium-sized cities. Such efforts can relieve the strained infrastructure of a few large cities. They can also help spread the developmental activities all over the country. The concern of government should be shown by formulating appropriate policies. They have to create the basic infrastructure and services so as to attract entrepreneurs.

Reducing Problems of Over-Concentration of Population

The current process of urbanization is biased towards primate cities. All activities are concentrated in a few cities and everybody flocks there. The infrastructure and services available there are over-strained, the returns for investment are low, living conditions deteriorate, and large numbers cannot be supported well. The result is all sorts of social evils and shortages of services. Such dissatisfaction with large agglomerations is reflected in out-movement from several such areas in the developed countries.

There is therefore a need for counter-magnets so that migrants have alternate places for settlement. There should not be one track but several tracks to reduce traffic. The need exists to have policy measures so that no city becomes too large. This can be done in at least two ways. First, by posing legal restrictions and disincentives to movement to these cities. Second, a more feasible and desirable alternative will be to create other centres where attractive opportunities are available to migrants. Some attractive features of large metropolitan areas could be brought to the medium-sized cities so that migrants move to these cities instead of to the large ones. It is a matter of some initiatives and some incentives; soon migrants will follow migrants to medium-sized cities. This will bring a balanced growth of urbanization to all regions. The full benefits of urban development will be achieved without adverse effects of concentration in large cities.

III POPULATION DYNAMICS OF MEDIUM-SIZED CITIES

A list of 22 medium-sized cities in Asia (excluding China,) and their population size in and around 1980 is given in Table 1. It may be noted that there is only one medium-sized city each in Afghanistan, Bangladesh, Islamic Republic of Iran and Turkey. The Republic of Korea and Philippines have two medium-sized cities. Indonesia has three, India  five: and Japan six.

Refer to Table 1

Change in Percent of Urban Population in Asia

A set of rural-urban projections prepared by United Nations divides cities into four size categories: those with population of less than one million, 1-2 million, 2-4 million and 4 million and over (United Nations, 1985). The percentage of urban population living in these four size categories in the years 1950, 1970, 1980 and 2000 for the World, developed regions, developing regions and Asia are given in Table 2. The major findings include the following.

(a) The increase in percent of population living in cities of 4 million and over developed regions between 1950 and 1980 has been almost nil -14.1 percent from the level of 12.5. But the increase is as high as 50 percent in the same period in the developing countries. In Asia too, there has been substantial increase in the percentage of urban population living in cities of 4 million and over between 1950-1980.

Refer to Table 2

(b) It is projected that the percent of the population living in cities of 4 million and over in developed regions will start declining after 1980. It will decline from 14.1 percent in 1980 to 13.4 in 2000. But these percentages will continue to increase in the developing regions and Asia. That is, people in the developed regions have seen the problems of large cities and therefore government policies and conscious efforts of people will change the pattern of settlement in urban areas in the next 20 years. The countries of the developing regions should take lessons from this experience.

(c) The percentage of population in cities of size 2-3 million has been increasing in all regions of the world; slowly in the developed regions and rapidly in the developing. The increase was nominal, from 6.8 percent in 1950 to 7.9 in 1980 in the developed region but was relatively high in Asian countries where it increased from 3.9 percent to 6.3. This percentage is going to increase further during next 20 year period, 1980-2000.

(d) In the case of medium-sized cities (1-2 million), the percentage change in population during fifty year period 1950-2000 is very slow in all region, from about 9 to 11 percent.

Refer to Table 3

Change in Number of Cities in Different Size Categories in Asia

Projections have also been made of the number of cities in different size categories during the period 1950 to 2025. Table 3 shows them at four points 1950, 1970, 1980 and 2000 .The highlight from this Table include the following.

(i) The number of cities of 4 million and over will increase slowly in the 50 year period, 1950-2000 in the developed region. The increase will be rapid in developing region. Their number will swell by a factor of ten, compared to only a factor of two in the developed region during the same period. In Asia too, the number will increase sharply becoming six times as large as in 1950.

(ii) The number of cities in the size categories 2-3 million and 1-2 million will increase quite sharply all over the world. The largest increase has been projected for the period 1980 to 2000.

Large and Medium-Sized Cities in India, 1981

Twelve Indian cities with a population of more than one million in 1981 are listed in Table 4 with their population (Census Commissioner of India, 1981).

Refer Table 4

The twelve urban agglomerations form about 26.9 percent of the total urban population of India. That is, more than one-fourth of the country's urban population lives in cities with more than a million population.

There are only five medium-sized cities (1-2 million) in India and they are noted at the bottom of the list of twelve cities given in Table 4. This paper will discuss the population dynamics of these five cities. For comparison, other large agglomerations will also be shown. For this purpose, the twelve urban agglomerations have been divided into three size categories. The first category consists of the four metropolitan areas of Calcutta, Bombay, Delhi and Madras, with a 1981 population of more than 4 million, though it may noted that the population of Calcutta and Bombay is twice as large as that of Madras. The second category consists of the three cities of Bangalore, Hyderabad and Ahmedabad, each of which has a population of 2 to 3 million. The third category is medium-sized cities as defined in this paper.

Decadal Population Growth of Medium-Siied Cities in India

The decadal growth rates of medium-sized cities in India (1921-81) are given in Table 5. Kanpur and Lucknow, both in Uttar Pradesh, the most populous State of India, have apparently expanded up to their limit and therefore the rate of growth in these two cities has started declining.

Refer to Table 5

Pune and Jaipur are two cities where population grew very rapidly in 1961-71 and continued to grow rapidly in 1971-1981 but at a reduced rate. Nagpur had an acceleration in growth in the pre-independence period and its population is still continuing to grow, but the rate of growth has declined after its reorganization, when it was merged into Maharashtra.

It would seem, therefore that a medium-sized city grows very rapidly in the beginning. It then continues to grow but its rate declines in the second phase. The third phase may be when population either stands still or declines (none of the medium-sized cities in India has reached this stage).

Comparison of Decadal Population Growth of Medium-Sized Cities with Larger Cities

The decadal growth pattern of medium-sized cities has been compared with large-sized cities, in urban and in total population of India in Table 6. The following significant findings emerge.

Refer to Table 6

(a) The rate of growth of the urban population in India is about 50 to 100 percent higher (depending on the size category of city) than the total population of the country,

(b) The rate of population growth of three size categories of cities (4 million and over, 2-3 million and 1-2 million) is similar except it is particularly high for the city size 2-3 million in 1971-81. In other words, cities of size 2-3 million are increasing rapidty. But the net addition of people in cities of size 4 million and over is much higher, even though the rate of population growth is less than in the size category 2-3 million, because of large base population of these cities. The Table below shows the actual number of additions in different size cities in the decade 1971-81.

(c) The population growth of cities of 4 million and over, (Calcutta, Bombay, Delhi and Madras) has shown a decline in the decade 1971-81 compared to 1961-71, though the rate is still high and comparable to medium-sized cities.

(d) There is a slowly increasing trend in the growth rate of population in the medium-sized cities in India, from 35.4 percent in 1951-61 to 36.2 and 38, in the two decades 1961-71 and 1971-81, respectively. This slowly increasing trend in the growth rate contrasts with the rapid increasing trend in cities of size 2-3 million and the slower decline in growth rate in the largest size cities.

(e) The rate of population growth of the city size category 2-3 million is increasing rapidly. There is a risk that three cities in this category (Bangalore, Hyderabad and Ahmedabad) are soon going to become too large for the available infrastructure and services to support the population adequately. These cities may start facing the social, economic and environmental problems now found in cities like Calcutta, Bombay and Delhi. There is a need to initiate measures to divert the population of these cities to those of size 1-2 million and even smaller to avert deterioration there.

(f) The medium-sized cities, as a group, added 1.9 million population in the decade 1971-81. This addition is going to increase in the coming years. There is a need therefore to have advance planning to ensure adequate social and economic opportunities and daily amenities in these cities to keep migrants and the native residents satisfied.

Therefore, the cities of size category of 4 million and over are going to have a reduction in the rate of population growth in the future. There is sharp increase in the cities of size category 2-3 million and a slower increase in those with population size of 1-2 million.

Other Population Characteristics

Information was also available on a few other urban population characteristics in the five medium-sized cities and other large cities in India (Census Commissioner of India, 1983). These data are shown in Table 7. About four percent of the urban population in 1981 lived in medium-sized cities of India. These percentages for the city sizes of 2-3 million and 4 million and over were 5.1 and 17.6, respectively. These figures suggest that urbanization has been so far heavily concentrated in four large agglomerations in India. A slight decrease in the rate of growth there in the recent decade (1971-81) is welcome though the numbers (of people) added to these urban agglomerations are still very large and require immediate attention.

The density in medium-sized cities is 5,380 persons per square kilometer. Though this is an aggregated value for all cities together, the variation among cities is great. The range of variation extends from 4,832 for Jaipur to 6,904 for Lucknow. It may be noted that this variation in density is reflected in the rate of population growth of these cities (Table 7).

Refer to Table 7

As a comparison, the density of the medium-sized cities is much lower than the other two categories of cities -7,000 and 10,692, respectively for city size categories of 2-3 million and those with population of 4 million and over.

The density in large agglomerations of India has considerable variation. In Bombay more than 13,000 people live in a square kilometer of space compared to only 7,500 in Madras. In Calcutta and Delhi there are about 10,000 people per square kilometer.

Thus the population density in medium-sized cities in India is still relatively low, suggesting a potential for diversion of people from higher density areas of the larger cities of 4 million and over.

About 5.6 members live in each occupied household in the medium-sized cities in India. This number is similar to other categories of cities except in cities with population of 4 million and over where it is slightly less (5.3). Even in this category, the number of people living in each household in Delhi is 5.6, comparable to medium-sized cities and cities of 2-3 million.

Another point which is interesting in the population dynamics of urban growth in India is the beginning of a decline in the percentage of urban population living in large agglomerations. This percentage has declined from its peak of 18.5 in 1971 to 17.5 in 1981. There is corresponding increase in the percentage of population in city size category of 2-3 million. The medium-sized cities have been retaining almost similar percentages in all the four censuses for which data are given "(Table 8).

Refer to Table 8

IV POPULATION PROFILES OF MEDIUM-SIZED CITIES

The population profile of a city will depend on its natural growth and the characteristics of its migrants. The characteristics of migrants, in turn, will depend on the opportunities available in the receiving city. For example, cities with industries are likely to attract more male labor in contrast to cities with offices where female staff is needed for office work. The intensity of the migratory volume will also determine the profile of the urban area. If the migration volume is small, its effect on the population profile will be nominal and the profile will be determined by the natural growth of population. A heavy migratory movement, on the other hand, has a stronger impact on the profile, which will then be determined by the type of people who are net migrants. Since demographic and socio-economic characteristics of migrants have repercussions on the sending and receiving areas, the planners and policy makers require such information for need-based planning. Therefore this section attempts to give profiles of people living in  medium-sized cities.

It may be stated that very limited information is available on the profiles of medium-sized cities because it requires detailed cross-tabulations of the census data. The data of this type have not received priority except in some developed countries where individual scholars have themselves undertaken full-fledged projects to study the population dynamics of cities. Such specialized study requires raw data which may or may not be readily available. Even in such studies, interest has focused on large metropolitan areas which have particularly drawn the attention of programme planners and administrators because of various types of problems there. The need for planning in such cities had been felt in order to minimize their problems. Information on the profiles of medium-sized cities is almost non-existent, except for some scattered information on some components of the population living there.

With the support of the Census Commissioner of India, the author could obtain some information on their profiles. Thus efforts have been made here to fill some gaps in the profiles of medium-sized cities. Both demographic and socio-economic characteristics have been presented. The data are mostly from the 1981 census of India, though some generalized information from other sources has also been used for this purpose.

Natural Increase in Population

There is no direct information available on the levels of birth and death rates in medium-sized cities, but the allied characteristics of the population living in these cities are suggestive of their level. The crude birth rate is determined by balancing the effect of the four factors: (i) migrants form a relatively small fraction of the total population of these cities; (ii) the educational level of medium-sized city dwellers is slightly higher than general population and almost equal to the urban population in general; (iii) there is a negative association of educational level with fertility; and (iv) more young people are likely to be migrants and they are either just married or likely to marry soon and thus will contribute to births. The crude birth rate in the medium-sized cities therefore may be comparable to that of the urban population in general. The same argument suggests the level of death rates in medium-sized cities will also be comparable to the total urban areas.

Thus the level of natural increase in medium-sized cities will be equal to that of urban areas. In India, the rates of natural increase in urban and rural areas is quite similar. Both birth and death rates in urban areas are lower than the levels in rural areas but the rate of natural increase is quite similar (Registrar General of India, 1985). Therefore we expect that the rate of natural increase in medium-sized cities is equal to that, of urban areas which is equal to that of rural areas.

Age Distribution

Migration is a function of age. Of the potential pool of migrants, those who are young and energetic are more likely to move. Similarly migrants tend to have more initiative and better education. In the case of medium-sized cities in India, the percentage of young adults who belong to productive age groups (15-59) is much higher (58 percent) than for the general population of the country (53.9 percent). But it compares well and is similar to the age distribution of the urban population as a whole in the country. (Table 9) That is, the age distribution of medium-sized cities is similar to that of the country's urban population. The same was the case for cities of 2-3 million population. But cities of larger size, 4 million and over, had much higher percentages of young productive age groups in the population than did the medium-sized cities.

Another fact which emerges from the Indian data is that the child population (0- 14 years of age) in the cities of size category 4-million and over was much less (32 percent) than in other city size categories (about 36 percent); the latter proportion was not different from the total urban population, however. It may be noted that this profile is at a point in time but has no reflection on the characteristics of migrants.

Dependency Ratios

A clear trend in the dependency ratio is noticed among different size categories of cities (Table 9). While the overall dependency ratio in India is 855, it reduces to 724 for urban areas. The decline is continuous with the increase in the size of cities. There is some similarity in the level of dependency ratio in cities of size 1-2 million and 2-3 million. This reduces sharply for primate cities where there is a heavy concentration of young population.

Sex Distribution

Migration most often is male dominated in Asian countries except for the Republic of Korea and the Philippines where female migrants outnumber the males. The table below shows sex ratios (males per 1000 females) of migrants for some Asian countries:

In the case of India some information is available on the sex ratios of cities in different size categories (Table 9). The overall sex ratio in the country is 1029, increasing to 1136 for urban areas. It is still higher for medium-sized cities and cities of 4 million and over where it becomes 1168 and 1247, respectively. In the case of cities of size category 2-3 million, there is some decline in the sex ratio even compared to general urban population, 1118 compared to 1136 in the total urban population. This decline suggests a greater movement of females than males to this category of cities. This pattern of migration has been emphasized in a recent review of patterns of internal migration in ESCAP countries where it is stated (ESCAP, 1984):

"The recent trend in south-east Asia is towards a much greater participation of young women in migration. The new industry in these countries is generally characterized by light industries which afford opportunities for women. Women are also more easily absorbed into the rapidly expanding clerical and service sectors of the cities."

Literacy Status

Another almost universal characteristic of migrants is that they tend to have higher educational levels than non-migrants in the area of origin, but lower than those in their place of destination. In India, data were available on percentage of literates in different sized cities for males and females. This index (percent literates) was much higher for the urban population than the general population. There were 65.8 percent male literates in urban areas compared to 46.9 in all India (Table 10). This rate was almost two times in the case of females (47.8 percent in contrast to 24.8 in India).

The percent literacy shows a continuous increase with city size. The increase is only marginal, however, for medium-sized cities; the percent of male and female literates there were 68.2 and 51.3 compared to 65.8 and 47.8 percent for urban areas.

Economic Activity

From the point of view of policy, the most significant characteristic is economic activity. There is a need to know the degree of unemployment and under-employment in the cities so that measures can be taken to reduce their numbers. The saying that "an empty mind is a devil's workshop", looks to be very appropriate for urban areas. One often reads about law and order problems in the cities where unemployment and under-employment is large.

Refer to Table 9

There is no information available on employment or unemployment specifically for medium-sized cities. The condition of all urban areas might be true in the case of this category of cities, however. Therefore some findings from other urban studies are given here. Results of some recent studies have shown that urban migrants generally have lower levels of unemployment than natives of the urban areas. The activity rates of the younger migrants are much higher than those of urban natives in the same age group (Institute of Economic Research, 1980). It was also found in a study in Indonesia that migrants are engaged in services and have relatively lower income. Many enter  "informal sector" activities. Intuitively, it seems that migrants contribute indirectly to unemployment rather than directly by taking jobs which otherwise would have gone to natives. It is also equally likely that they take jobs which would not be acceptable to the urban natives. Higher aspirations of the urban elites may partly explain the higher levels of educated unemployed.

The Indian 1981 Census publications have not provided such data. They have divided the urban population into three broad categories -main workers, marginal workers and non-workers. While the first category includes those who had worked for more than 183 days in the previous year (previous to the date of enumeration), the second category covers all those with less than 183 days work. Non-workers were those who had not worked at all in the year preceding the date of enumeration. Because no effort has been made to exclude those who are not supposed to be economically active, the percentage of non-workers does not reflect unemployment or underemployment. The distribution of the total urban population in medium-sized cities in these three categories of workers - main workers, marginal workers and non-workers is shown in Table 10. Those figures might partly reflect under-employment and unemployment though, as stated above, one has to keep limitations of these figures in mind. Such figures for two other categories of city sizes are also shown. They are not comparable amongst themselves because of different age distribution of these city size groups.

V POLICY  IMPLICATIONS

Migration is generally explained in terms of a balance of pull and push factors. The social and economic differentials between different areas decide the movement. Areas of better socio-economic opportunities become magnets and pull people from the areas where stability of social and economic levels is disturbed by rapid population growth. Thus migration becomes an automatic response to socio-economic conditions of a society, with deterioration acting as a push factor and opportunities elsewhere as a pull factor.

Currently, most developing countries have been facing pressures of rapid population growth. The pressure on agricultural land has been increasing in spite of high-tech methods adopted for cultivation. People have been moving out not so much for greener pastures but mostly just to earn their day-to-day living.

Refer to Table 10

This is clearly indicated in the near universal increasing rates of urban population growth.

The movement of people from rural to urban areas has social and economic consequences, both for sending and receiving areas. The movement from the rural areas is almost inevitable. All efforts should be made to optimize it so that its disturbing effects can be minimized. Efforts should also be made so that the urban movement does not bring economic or social suffering either to sending or receiving areas. On the contrary, the urban movement should assist the process of development. For this purpose policies are needed to make sure that sending rural areas are not depleted of their productive workers. It should be a process of reduction of pressure on land and not out-migration of developed manpower.

The next step in migration and urbanization is the place of destination of the migrant. Obviously one would like to remain close to friends and relatives in the original place, provided nearby areas can offer at least part of what one moves for. There is another factor of "Pull" or relative attraction of different places where one can possibly go. Therefore the opportunities of an area of destination and the proximity to the original place of residence are two factors which determine where a migrant will settle down. Which one is important is not known. Nor has there been need to know of their importance because, until recently, a migrant had no choice but to go to a few selected areas where opportunities existed. Other places did not have opportunities at all. The result was a heavy concentration of population in a few urban agglomerations.

A few primate cities grew, but the potential of other urban areas remained dormant and unharnessed. The rapid growth of pockets of large urban concentrations in the developing countries and the Asia region since 1950 are evidence of the almost one track movement of migrants. It is only recently that slum settlements, unemployment, and an increase in social problems like crime and the breakdown of law and order have been linked with overcrowding of these metropolitan areas. There is almost universal concern for avoiding such over-urbanized pockets. The alternatives are being examined and several policies have been implemented to influence the volume and direction of movement. A recent survey has revealed that several countries have shown greater concern for the problem of population distribution than of high fertility which has been the major concern for the last two to three decades. The process of adjustment in the pattern of urbanization has started, though success has been limited as pointed in different papers (ESCAP, 1984b; Kuroda, 1984; Young, 1984).

Recently some authors have suggested concepts like growth centres, regional balance in development, and balanced spatial distribution for the overall development. This represents a tilt from urban bias to development. The idea is that if developmental activities are undertaken in rural areas and cities around them, then migrants will not have a tendency to concentrate only in a few large urban agglomerations. They may spread themselves, probably settling down close to their original place of residence. The results will be balanced growth of all areas rather than a few selected pockets. Additional advantages of this type of planning include:
(i) large urban agglomerations will neither increase in number nor will the existing ones continue to grow in size;
(ii) there may even be return movement from such places of concentration because being in such places has been realized to be unhealthy; and
(iii) the migrants will keep in close touch with rural areas where they belong socially and culturally and which provide them with moral sup- port. In return, the migrants will carry back new ideas of modernization during their home visits. Such traditional support and modern ideas can themselves become a strong force for development.

This means that there is need for a conscious policy to discourage concentration in large agglomerations and encourage people to move to small and medium-sized cities. Analyses of population dynamics of different city sizes in India have shown that the rate of growth of cities of 2-3 million has been increasing recently and the growth rates in large cities have slightly declined. Though there is need to accelerate the process of decline in the rate of population growth of large cities, it is necessary to take appropriate measures to ensure that cities of 2-3 millions do not reach the current size of Calcutta, Bombay or Delhi. The time has come to encourage greater movement to medium-sized and even small size cities. The development of rural areas can also reduce the influx of migrants. The idea is to reap benefits of urbanization and avoid its adverse effects.

A rapidly increasing population has a tendency to push people out looking for means of livelihood. The degree of such movement can be reduced by bringing some measures to develop rural areas. There is need to raise income in rural areas by expanding employment opportunities, particularly in the off-farm sector. Some measures also should be taken to promote agricultural development. Several Asian countries have undertaken experiments in this type of development and the results are reassuring (ESCAP, 1984).

In order to bring a balanced growth of medium and even small-sized cities, some countries have initiated efforts, but much more needs to be done. Some more stringent measures will be needed. Since these cities are currently growing mainly by natural increase, there is need to slow down this source of addition of people. For this purpose, the birth rates in these cities must be reduced. A strong family welfare programme has been found to be essential for reduction in fertility. Therefore it is necessary that family welfare programme education and service activities in these cities be strengthened.

There will also be need to take steps to bring about the economic development of medium-sized cities. They have to be made economically and socially attractive to give their pulling magnets some strength. The Republic of Korea provides an example of efforts to reduce the primacy of Seoul by improving regional distribution of productivity and income. The resources available there have to be fully exploited. The initiative for these actions has to come from the Government, though public sector undertakings can also stimulate the private investors (Bose, 1984). In order to accelerate this process some of the development activities of the primate cities may even be shifted to medium-sized cities to reap the dual benefit of making these areas attractive and primate areas less attractive.

There is also a need to ensure that no more economic activity which could be attractive to migrants is allowed to be started in large urban agglomerations. Everything should go to cities of other size categories, preferably medium-sized cities. Policies should even be formulated to encourage shifting of the existing activities to medium-sized cities. Some disincentives and controls, which have been initiated by a few countries, could also be helpful in this regard (Simmons, 1979; Mera, 1981)

In order to avoid deterioration in living standards in the medium-sized cities, adequate economic and social infrastructure and services have to be developed. This development should keep in view the future growth of these cities. Also these cities should not be allowed to grow beyond the available infrastructural and service facilities. It will be more cost-effective to invest money in medium-sized cities than large cities. This point has been illustrated in the case study of India's Health and Family Welfare Programme (Noted below).

There is also a need to strengthen linkages between medium-sized cities and the hinterland so that movement to medium-sized cities is facilitated. All facilities should be created for migrants to keep contact with their place of origin, so that they may bring new and modern ideas to the rural population. Specific policies to develop better communication and transportation between these areas are needed so that close linkages can be fostered. Such measures will have a great return for the overall development of the country.

It may be stated that however we may wish to restrict growth of large cities, the attractive features of these cities are going to continue to pull people in them in spite of all their problems. Of course, this inflow will be on a reduced scale if some of the measures suggested earlier are accepted. Therefore some measures need to be taken to ensure that these large cities do not become chaotic. This calls for a massive mobilization of resources to cope with housing, sanitation, transportation, pollution and other associated problems. Everybody living there should get the basic amenities of life, like water, electricity, housing, transportation and health facilities. This will require careful planning even for these cities keeping future growth in mind. A recent effort of the United Nations in organizing a conference in Barcelona is commendable and a set of useful recommendations have been made to avert further problems in these cities (United Nations, 1986). In other words, there is a need for a sincere and serious effort to regulate patterns of urbanization so that its developmental potential can be fully harnessed. A comprehensive plan should cover rural areas, small and medium-sized cities and the large urban agglomerations to bring about balanced growth of the country.

NOTE
Relative Advantages of Investment in Health and
Family Planning in Medium- and Large-Sized Cities

This note discusses advantages and disadvantages of investment in health and family planning activities in medium-sized cities relative to large cities. The arguments given here are based on the experiences of the Indian Programme.

Current Situation

The health infrastructure in India is hierarchical. A health service system has been created at different levels to provide services at the door steps. Medical units at each level have support from the higher level for specialists' services through a system of referrals. Every higher level unit therefore has more sophisticated and modern equipment to meet the requirements for specialist's services. For instance, the lowest service unit is a Sub-health Centre manned by a paramedical worker called an Auxiliary Nurse Midwife (ANM), and a male Health worker. The ANM has 1.5 years of professional training after her high school. At the next higher level is Primary Health Centre where services of medical and paramedical staff are available. The idea is that whenever an ANM or a male Health Worker feels a need for more specialized care, they can refer patients to the Primary Health Centre. Cases requiring even further consultation are referred to Taluka, District or State Hospitals or even to national institutions depending on where the case requires attention. Thus it was envisaged that medical services would be available to everybody near their doorsteps. Only those requiring specialized attention go to the higher level medical institutions located farther away from their homes.

Though planners of Indian medical services had planned well and created a system whereby all levels of services could be obtained by everybody without too much inconvenience, the actual situation is quite different. Currently, only a few patients care to go to Sub-health Centres or Primary Health Centres. They directly go to the hospitals where they feel they will receive better services. The result is that the basic units of primary health care are under-utilized and the infrastructure of hospitals is over-strained. It is particularly so in the case of national level institutions where everybody wishes to go for services and which mostly exist in large societies. Thus a problem similar to that of urbanization in general is clearly evident in the medical services. The medical hierarchy has its counterpart of the primate city. People go directly to these national level institutions by-passing those at the lower level. The results are similar to the over-urbanization of large cities at the cost of under-utilization of the Primary Health Centres, Taluka and district level medical facilities.

This uneven pattern of utilization of medical and health services has affected the quality of services at all levels. The under-utilization of services at peripheral units has affected the morale and interest of the workers there; they have lost initiative and interest and find no satisfaction in their work. They do not even have interest in their profession because all their equipment is old and outdated. New and modern equipment goes to pioneer hospitals, which thus attract all good doctors and most of the patients. No doctor wants to stay at the peripheral unit. This has affected the quality of services at all levels. The lower units either do not have staff or have it without zeal and enthusiasm, and the large hospitals are over-crowded. The large influx in these institutions is probably contributed by (i) large hospitals with more facilities (ii) good doctors with much experience, and (iii) referrals which take them from place to place.

Need to Change the Situation

There is need to do something to reduce pressure on pioneer medical institutions located in large cities. This could be done both by discouraging people from going to large institutions for routine services and by providing higher quality services at peripheral units. In other words, there is need to take policy measures to (i) make peripheral services more attractive so that all the facilities created should be fully utilized, (ii) avoid an unnecessary rush to the pioneer institutions where only referred cases should be entertained, and (iii) provide quality services at all levels so that clients are satisfied with health services.

Recommendations

In order to achieve these basic goals, the following recommendations are made.

1. The services in the lower units like Primary Health Centres, Taluka and district hospitals should be improved. For this purpose (a) periodic reorientation of doctors, (b) supply of better and latest equipment, (c) better infrastructural facilities, and (d) correcting deficiencies of these hospital service units, are some of the needed measures.

2. Some policy measures should be taken to discourage patients from bypassing the lower units. Only referrals should be entertained in the institutions of specialization.

3. The family welfare educational needs of the rural areas and small-sized cities are relatively higher because of the background of the population living there. Thus more intensive and extensive educational efforts should be made in these areas even at the cost of budgets of large cities where the background of the population does not require such heavy efforts.

The resources of the developing countries are limited and thus allocation to the health and family planning programmes are fixed. In such situations, it will be more cost- effective to invest more health funds in the rural area and small towns than in the large city hospitals. The improved services in small areas will go a long way to bring satisfaction to the people and they will use services there. At the same time services at the large units will also get better because of less crowding. This suggestion is similar to the one made in the case of over-urbanization of large cities.

Moreover, a small reduction in the financial allocations to the large hospitals can go very far in strengthening services in the lower units. Therefore the cost-effectiveness of the diversion of resources from large hospitals to the lower level medical unit is favourable and should be considered seriously. It will also reduce wastage of resources invested on the peripheral units, which are now industrialized.

References

Bose Ashish, 1984. "The Role of the Medium size cities in the urbanization process". Third Asian and Pacific Conference, Colombo, 1982: Selected Papers. United Nations 178-186.

ESCAP, Population Division, 1984a. "Internal Migration in the Countries of the ESCAP Region", Third Asian and Pacific Population Conference, Colombo, 1982: Selected Papers, (Bangkok: United Nations), pp. 194-211.

ESCAP, Population Division 1984b. "Urbanization in the ESCAP Region", Third Asian and Pacific Conference, Colombo, 1982: Selected Papers, (Bangkok: United Nations), pp. 158-177.

India, Census Commissioner, 1981. Provisional Population Totals: Rural-urban distribution, Paper 2 of 1981. Series-1, India.

India, Census Commissioner, 1983. Primary Census Abstract: General Population, Part IIB(i), Series-1, India.

Institute of Economic Research, Osaka, 1980. Studies in Sri Lanka, Indonesia and India, (Osaka).

Kuroda Toshio, 1984. "Working Paper," Third Asian and Pacific Conference, Colombo, 1982: Selected Papers, (Bangkok: United Nations), pp. 189-193.

Mera K, 1981. "Population distribution policies: the need for caution", Population Distribution Policies in Development Planning, New York: United Nations), E81. XIII.5.

Registrar General of India, 1985. Sample Registration Bulletin 19(1), June.

Simmons, A.B.,'1979. "Slowing Metropolitan City Growth in Asia. Policies, Programs and Results," Population and Development Review, Vol.5, pp.87-104.

United Nations, 1975. "The Population Debate: Dimensions and Perspectives," Papers of the World Population Conference, Bucharest, 1974. Vol. I & II.

United Nations, 1984. Demographic Yearbook.

United Nations, 1985. Estimates and Projections of Urban. Rural and City Population, 1950-2025: The 1982 Assessment, ST/ESA/SER.R/58.

United Nations. 1986. "Barcelona Declaration on Population and the Urban Future", International Conference on Population and the Urban Future, Barcelona, Spain, 19-22 May.

UNFPA, 1986a. United Nations Population Fund, Conference on Population and Small and Medium-sized cities in Latin America and the Caribbean, Mexico City, 24-28 February.

UNFPA, 1986b. United Nations Population Fund, Report of the International Conference on Population and the Urban Future, Barcelona, 19-22 May.

Young Mei Ling, 1984. "Circular Mobility and its Policy," Third Asian and Pacific Conference, Colombo, 1982: Selected Papers, (Bangkok: United Nations), pp. 224-237.