Key Details
The EAC-PM working paper The Ghost of Population Past: How Population Control Persists in India examines fertility data, state family-planning budgets and administrative practices.
Indicator | Finding presented in the paper |
|---|---|
National total fertility rate | 1.9 in SRS 2024; 2.0 in preliminary NFHS-6 data |
Annual births | Approximately 23.2 million in 2023, down from a peak of 29.3 million in 2001 |
India excluding Bihar and Uttar Pradesh | Estimated TFR of 1.6 |
India excluding six higher-fertility states | Estimated TFR of 1.4 |
Urban and rural fertility | Urban TFR 1.5 and rural TFR 2.1 in SRS 2024 |
Family-planning allocations | 79.3% of comparable allocations went to terminal methods in 2025–26 |
Andhra Pradesh | Removed sterilisation-incentive allocations from its 2026–27 plan |
Tamil Nadu | Budgeted incentives for 1.6 lakh female sterilisations while extending maternity leave for a third child |
Total fertility rate (TFR) is the average number of children a woman would have over her reproductive life if current age-specific fertility rates continued.
India’s Low-Fertility Transition Is Uneven
India’s national TFR fell to 1.9 in 2024, below the conventional replacement benchmark of 2.1. The working paper calculates that India’s effective replacement level was historically higher because of child mortality and a male-skewed sex ratio at birth—declining from approximately 2.4 in 2000 to 2.2 in 2024.
The national average conceals substantial state differences:
Above their estimated replacement level: Bihar, Uttar Pradesh, Madhya Pradesh, Rajasthan and Chhattisgarh.
At replacement: Jharkhand.
Long below replacement: Andhra Pradesh, Karnataka, Kerala, Tamil Nadu, Maharashtra, Punjab, West Bengal and several other states.
Excluding Bihar and Uttar Pradesh, India’s estimated TFR is 1.6. Excluding the five above-replacement states and Jharkhand, it falls to 1.4.
India therefore no longer faces one demographic problem. Some states continue to need strong reproductive-health, maternal-health and voluntary family-planning services. Others must prepare for ageing, slower workforce growth and a declining share of children.
Population Growth Now Reflects Demographic Momentum
Annual births are estimated to have peaked at 29.3 million in 2001 before falling to approximately 23.2 million in 2023—the same level as around 1974.
India’s population can continue growing despite below-replacement fertility because a large cohort is still entering reproductive age. Longer life expectancy and lower mortality are also increasing the number of people at older ages.
This is demographic momentum: population growth continues temporarily because of the population’s age structure, rather than because women are having more than a replacement number of children.
Public policy therefore needs to look beyond the absolute population count and pay closer attention to fertility, births and the changing age structure.
A Voluntary Programme Retains Population-Control Incentives
India formally ended centrally imposed, method-specific family-planning targets in 1996. The current programme is designed to be voluntary, rights-based and target-free, while the Supreme Court has directed governments to move away from coercive sterilisation camps.
The EAC-PM paper nevertheless identifies financial and administrative features that continue to favour terminal contraception:
payments to people undergoing sterilisation;
compensation for wage loss;
payments to healthcare providers and facilities;
incentives for ASHAs or other workers who motivate acceptors; and
an additional ASHA payment when a couple adopts a permanent method after two children.
In Mission Parivar Vikas states, some payments for terminal methods are five to ten times those associated with selected reversible methods. Under the incentive schedule examined, an ASHA can receive up to four times as muchfor motivating a terminal method combined with the two-child limiting incentive as for a reversible method.
These comparisons reveal the incentives built into programme design. They do not establish how often a payment determines an individual contraceptive decision.
Budgets Remain Weighted Towards Terminal Methods
An analysis of state National Health Mission Records of Proceedings puts the share of comparable family-planning allocations directed towards male and female sterilisation at 79.3% in 2025–26. The remaining 20.7% covered intrauterine devices and injectable contraception.
The figure requires careful interpretation:
State budget documents are not standardised.
Sterilisation headings can include equipment and minor expenses alongside DBTs.
Several temporary contraceptive methods are excluded because their budgets are not reported consistently.
Allocations indicate planned spending — not procedures completed or the quality of consent.
Even with these limitations, the distribution raises an important question: whether public financing is consistent with informed choice and a balanced contraceptive mix.
State Policies Are Beginning to Pull in Different Directions
Two states illustrate how demographic policy is changing unevenly.
Andhra Pradesh changes course
Andhra Pradesh has a TFR of 1.4, while approximately 70% of married women are sterilised, according to the preliminary NFHS-6 figures cited in the paper.
The state has:
removed sterilisation-incentive allocations from its 2026–27 plan;
repealed the two-child restriction on contesting local elections; and
proposed cash, education and insurance support for larger families.
The proposed pronatalist package is estimated to cost nearly ₹1,000 crore annually, compared with around ₹12 crore previously allocated for DBTs associated with 1.25 lakh female sterilisation procedures.
The comparison illustrates the potential fiscal difficulty of trying to raise fertility after small-family norms become established. It does not demonstrate that the proposed benefits will increase births.
Tamil Nadu sends conflicting signals
Tamil Nadu, with a TFR of 1.3, extended maternity leave for women government employees to one year for a third child in 2026. Its family-planning budget simultaneously provided for DBTs associated with 1.6 lakh female sterilisation procedures.
The two measures show how workforce, family and health policies can respond to low fertility at different speeds—and sometimes pursue conflicting objectives.
China Provides a Warning, Not a Direct Parallel
China retained its One-Child Policy for more than two decades after fertility fell below replacement. Its subsequent shift to two- and three-child policies did not restore fertility, which has since fallen below one child per woman.
India’s circumstances are materially different: its programme is formally voluntary, governance is federal and fertility varies widely across states.
The relevant lesson is narrower. Administrative systems can persist after demographic conditions change, while international experience suggests that cash payments and leave benefits have limited ability to reverse deeply established low fertility.
What the EAC-PM Paper Recommends
The proposed reforms focus on ending population control as a policy objective while retaining access to contraception:
discontinue DBTs, wage-loss compensation and provider payments linked specifically to sterilisation;
remove motivational payments for terminal methods and the ASHA incentive tied to stopping after two children;
repeal remaining state-level two-child disqualification rules;
end awards and official campaigns framed around population control; and
revise Mission Parivar Vikas and administrative terminology in states already at or below replacement fertility.
The paper does not advocate withdrawing contraception. It supports continued access for health, birth spacing and personal choice.
Policy Relevance
A state-sensitive reproductive-health framework is the most important implication. Fertility, age structure, maternal-health conditions and unmet contraceptive need now vary too widely for a uniform population-control approach.
Reform should preserve three objectives simultaneously:
Contraceptive choice: Women and couples need access to reversible and permanent methods without financial or administrative pressure towards a particular method.
Demographic differentiation: Higher-fertility states may require different health and social interventions from states facing rapid ageing and sustained low fertility.
Budget accountability: State plans should disclose expenditure by contraceptive method, beneficiaries reached, informed-consent safeguards and health outcomes in comparable formats.
A shift away from population-control incentives should also avoid an uncritical swing towards expensive pronatalist payments. Childcare, women’s employment, housing, healthcare and income security may matter more to family decisions than one-time birth incentives.
Follow the Full Working Paper Here: The Ghost of Population Past: How Population Control Persists in India