It has been well recognised that socio-economic development is the best contraceptive. India’s upward development trajectory over the past two decades has lowered fertility rates in most states. In recent years many couples are choosing not to have children or limit to one child because of concerns about costs to planetary environment of large population. Uncertainty about an unstable global economy and worries about global wars are also casting apprehensions about the future of children.
Family planning programmes have played a considerable role in increasing awareness on reproductive health issues. While family planning programmes have been successful, the impact has not been uniform across all of India. Some states have substantially reduced their total fertility rate (TFR) while others are above the net replacement rate. Lower levels of socio-economic development, lag in women’s education and restricted decision-making freedoms for female members of the household have been factors which have still kept TFR high in those states, apart from less efficient health systems which have a poor outreach of family planning services. Lower levels of female literacy and workforce participation as well as poorer outreach of family planning services in rural areas are responsible for the rural urban differences.
Education levels and attitudes of males also impact TFR. Males tend to place the onus of contraception on women. False notions of diminished virility or loss of sexual pleasure underlie their reluctance to adopt any form contraception. There is a need to change these attitudes and practices by promoting better health literacy and gender sensitivity among young men.
Despite the falling TFR, the Indian demographic profile will remain young till 2050. We need to focus efforts on promoting and protecting the health of our young people as well enables them to access suitable educational and employment opportunities, to reap the promise of a demographic dividend. Further, by educating women, providing more employment opportunities to them and abandoning regressive social attitudes which curb women’s choices, we can reap a “gender dividend”. By protecting the physical and mental health of elderly persons, we can also reap the “gray dividend” of their preserved productivity. So, a falling TFR does not clamp down our development in the foreseeable future.
(K Srinath Reddy is a physician and founder president of Public Health Foundation of India)
This column is part of the cover story "India’s sudden baby bust", originally published in the September 1-15, 2026 print edition of Down To Earth