The latest government report reveals stark regional disparities in fertility rates across the country
Category: Health
In a historic demographic shift, India’s Total Fertility Rate (TFR) has fallen below the replacement level for the first time, according to the Sample Registration System Statistical Report 2024 released by the Office of the Registrar General and Census Commissioner. The national TFR now stands at 1.9, dipping below the replacement threshold of 2.1, which is the average number of children a woman must have during her reproductive years to maintain a stable population across generations.
This decline marks a major milestone for the country, indicating a slowdown in population growth. Yet, the report highlights stark regional contrasts that reveal a complex demographic picture. For example, Bihar recorded the highest fertility rate in the country at 2.9, followed by Uttar Pradesh at 2.6, Madhya Pradesh at 2.4, and Rajasthan at 2.3—all states still above the replacement level. In stark opposition, Delhi reported the country’s lowest TFR at 1.2.
One of the most notable findings from the report is the persistent rural-urban divide in fertility rates. As of 2024, India’s rural TFR remained higher at 2.1 compared to 1.5 in urban areas. This trend is consistent across most major states and Union Territories, with the exception of Kerala, where urban fertility marginally surpassed rural rates, and Tamil Nadu, where fertility rates remained identical in both regions.
Over the past five decades, India's fertility rates have experienced a dramatic decline. The TFR dropped from 5.2 during 1971-1981 to 4.5, then to 3.6 in 1991, and now to 1.9 in 2024. Rural fertility fell from 5.4 in 1971 to 2.1, whereas urban fertility declined from 4.1 to 1.5 during the same period. Notably, Delhi recorded the sharpest decline in fertility over the last decade, witnessing a 29.4 percent reduction between 2012-14 and 2022-24. In comparison, Bihar saw the slowest decline at only 9.4 percent.
The report also examined the General Fertility Rate (GFR), which measures births per 1,000 women aged 15-49. Nationally, the GFR fell by 12 percent, from 78.8 during 2012-14 to 64.6 in 2022-24. The rural GFR decreased from 86.2 to 71.9, whereas the urban GFR dropped from 61.2 to 51.0. Again, Delhi led the way with a steep decline of 29.9 percent, with urban areas witnessing an even sharper fall of 35.6 percent. Bihar, on the other hand, maintained the highest GFR at 96 births per 1,000 women, followed by Uttar Pradesh at 83 and Rajasthan at 82.7.
Interestingly, urban Bihar was the only major state where urban fertility increased slightly over the decade, rising from 75.9 to 77.5 births per 1,000 women. This anomaly raises questions about the broader trends affecting urban areas across the country.
The findings from the report also highlight a widening demographic divide between India's ageing southern states and its younger northern states. For example, Kerala has 15.1 percent of its population aged 60 years and above, compared to Tamil Nadu at 14.2 percent. Conversely, Bihar remains one of India’s youngest states, with nearly one-third of its population below the age of 14.
Child survival rates reveal another layer of disparity. Under-five mortality rates stand at 41 deaths per 1,000 live births in both Madhya Pradesh and Uttar Pradesh, sharply contrasting with just 9 in Kerala. Rural India recorded a higher under-five mortality rate of 32, compared to 19 in urban areas. Alarmingly, early neonatal deaths account for the majority of infant mortality in India, with around 52.7 percent of infant deaths occurring within the first week of birth.
On the healthcare front, institutional deliveries have expanded significantly, with nearly 95.4 percent of deliveries taking place in healthcare institutions, including both government and private hospitals. Urban areas recorded 97.9 percent institutional deliveries, compared to 94.6 percent in rural India. Government hospitals accounted for 71.7 percent of all institutional births. Yet, the report highlights that access to medical care at the time of death remains uneven. Approximately 45.5 percent of deaths in India occurred without qualified medical attention in 2024, with this figure rising to 48.9 percent in rural areas.
Only 40.2 percent of deaths occurred in hospitals, with government hospitals accounting for 24.7 percent of medically attended deaths. This raises concerns about healthcare accessibility and the quality of care available, particularly in rural regions.
Marriage patterns across the country also show changing social trends. Nationally, 73.5 percent of women married at the age of 21 or above in 2024, with urban India showing a later marriage pattern—82.2 percent of women married after 21 compared to 70.2 percent in rural areas. Delhi reported no marriages below the age of 18, and Kerala recorded one of the lowest child marriage rates at just 0.04 percent, with over 80 percent of women marrying after 21.
In stark opposition, West Bengal recorded the highest proportion of women marrying before 18 at 6.3 percent, making it the only major state where fewer than half of women married after the age of 21.
The report also revealed that India’s sex ratio at birth stands at 918 girls per 1,000 boys between 2022 and 2024. Uttarakhand recorded the lowest ratio at 872, whereas Chhattisgarh and Kerala reported the highest figures at 978 and 974 respectively. This raises growing concerns about uneven demographic transitions across India, with some states facing rapid ageing and shrinking fertility, whereas others continue to experience relatively high birth rates and poorer health outcomes.
As India navigates this demographic transition, it faces the dual challenge of managing an ageing population in some regions, such as the south, and addressing high fertility rates in others, like Bihar. Policymakers will need to find a balance that ensures equitable healthcare access, supports families, and prepares for future demographic shifts.