Fertility and Mortality Trends

Fertility and mortality are the dual pillars of demographic transition models that govern the size, structure, and growth rate of an economy’s population. In population economics, these metrics dictate the velocity of human capital formation and the longevity of the demographic dividend.

• Crude Birth Rate (CBR): The number of live births per 1,000 individuals in a given population per year.
• Total Fertility Rate (TFR): The average number of children a woman would bear during her reproductive years (15–49) if she experienced current age-specific fertility rates.
• Replacement-Level Fertility: The specific TFR threshold at which a generation exactly replaces itself without net migration. This value is globally recognized as $2.1$.
• Crude Death Rate (CDR): The number of deaths per 1,000 individuals in a population per year.
• Infant Mortality Rate (IMR): The number of deaths of infants under one year of age per 1,000 live births in a given year.
• Neonatal Mortality Rate (NMR): The number of deaths of infants within the first 28 days of life per 1,000 live births.
• Under-Five Mortality Rate (U5MR): The probability of a child dying between birth and exactly five years of age, expressed per 1,000 live births.
• Maternal Mortality Ratio (MMR): The number of maternal deaths per 100,000 live births due to pregnancy-related causes during pregnancy or within 42 days of termination.

Macro Trends in Indian Fertility

The Historical Decline to Sub-Replacement Fertility

India’s demographic landscape has witnessed a rapid transition, transitioning away from high fertility rates. Data from successive National Family Health Surveys (NFHS) and the Sample Registration System (SRS) confirm that India’s national TFR has fallen below the replacement level of $2.1$.

Socio-Economic Determinants of Declining Fertility

The continuous reduction in fertility rates across the rural-urban spectrum is driven by several socio-economic transmission channels:

• Rising Female Literacy and Educational Attainment: Higher educational attainment directly correlates with a delay in the age of marriage and the first pregnancy.
• Urbanization and the Economic Cost of Children: The structural shift toward urban environments raises the direct expenditures on education and healthcare, shifting household preferences from child quantity to quality.
• Contraceptive Prevalence Rate (CPR): Modern contraceptive usage has expanded, driven by improved public health distribution and the scale-up of spacing methods.
• Reduction in Infant Mortality: As child survival rates improve, the behavioral “insurance effect”—where families have more children to ensure some survive to adulthood—diminishes.

Sub-National Heterogeneity and the Regional Divide

The national average masks deep geographic polarization in fertility transition across different states.

Low-Fertility Regional Clusters

The southern, western, and select northern states have achieved ultra-low fertility levels, echoing trends in developed nations. According to recent SRS and NFHS figures, Jammu & Kashmir (1.4), Goa (1.3), Sikkim (1.1), Kerala (1.8), Tamil Nadu (1.8), and West Bengal (1.6) exhibit TFRs far below the replacement standard.

High-Fertility High-Focus Clusters

The northern and central plains continue to exhibit higher fertility rates, though they are on a downward trajectory. Bihar reports the highest TFR at 3.0, followed by Meghalaya (2.9) and Uttar Pradesh (2.4). These variations stem from historical lags in female literacy, institutional health coverage, and deep-seated agrarian economic structures.

Macro Trends in Indian Mortality

Crude Death Rate and Life Expectancy Realities

India’s crude death rate has experienced a long-term decline due to expanding healthcare infrastructure, sanitation campaigns, and epidemiologic control programs. Concurrently, life expectancy at birth has risen significantly, creating a structural shift toward an aging population profile.

• Crude Death Rate (CDR) Compression: The national CDR has leveled off to approximately 6.0 per 1,000 population, with variations arising from regional age-structure compositions.
• Life Expectancy Expansion: Life expectancy at birth has increased to approximately 70.8 years, with female life expectancy consistently outpacing male life expectancy.

Child and Infant Mortality Metrics

The reduction of child mortality indicators marks a key milestone in India’s public health trajectory, outpacing global average rates of decline over the last three decades.

Major Clinical Causes of Child Mortality

According to the Office of the Registrar General of India’s Cause of Death Statistics, early-childhood mortality is highly concentrated around neonatal vulnerabilities.

• Prematurity and Low Birth Weight: Accounts for 44.7% of neonatal deaths and 31.6% of overall infant deaths.
• Birth Asphyxia and Trauma: Contributes to approximately 15.1% of newborn deaths.
• Acute Respiratory Infections: Neonatal Pneumonia accounts for 10.1% of mortality outcomes.

Maternal Mortality Ratio (MMR) Acceleration Drop

The Maternal Mortality Ratio in India has shown a steep reduction, declining from 130 per lakh live births in 2014–16 to 93 per lakh live births in recent survey cycles, representing an 86% decline compared to 1990 baseline estimates. High-performing states like Kerala (20), Maharashtra (38), and Telangana (45) have already surpassed the Sustainable Development Goal (SDG) target of keeping MMR below 70 per 100,000 live births.

Population Economy and Growth Implications

The Mechanics of Population Momentum

Achieving a sub-replacement TFR of 2.0 does not mean immediate population contraction. Due to the phenomenon of Population Momentum, India’s absolute population will continue to expand for a few decades. This is because a large cohort of youth, born during previous high-fertility decades, is currently moving through their reproductive years, ensuring that total births outnumber total deaths until the mid-2060s.

The Epidemiological Transition Risk

As infectious and communicable diseases decline, India is undergoing an epidemiological transition where non-communicable diseases (NCDs) constitute the majority of the national mortality burden. Cardiovascular diseases, chronic respiratory conditions, diabetes, and cancers account for over 60% of all recorded deaths. This structural shift requires reorienting public health financing away from episodic maternal-child care toward continuous tertiary care and geriatric management systems.

The “Ageing Before Affluence” Challenge

The rapid contraction of fertility in southern and western states has created a structural dynamic where these regions are aging at a faster pace than their historical economic growth. Unlike western nations that accumulated high per capita income before their dependency ratios inverted, these parts of India are encountering rising old-age dependency ratios at lower levels of per capita GDP.

Institutional Frameworks and Public Health Interventions

National Health Mission (NHM) Interventions

The Ministry of Health and Family Welfare executes several targeted programs under the Reproductive, Maternal, Newborn, Child, Adolescent Health and Nutrition (RMNCAH+N) strategy:

• Janani Suraksha Yojana (JSY): A 100% centrally sponsored scheme integrating cash assistance with institutional delivery to reduce maternal and neonatal mortality among low-income pregnant women.
• Janani Shishu Suraksha Karyakram (JSSK): Entitles all pregnant women delivering in public health institutions to absolutely free and zero-expense deliveries, including cesarean sections, drugs, diagnostics, and transport.
• Surakshit Matritva Aashwasan (SUMAN): Focuses on providing assured, dignified, respectful, and quality healthcare at zero cost, enforcing zero tolerance for service denial to mothers and newborns.
• Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA): Provides fixed-day, free, and comprehensive antenatal care packages to all pregnant women in their second or third trimesters on the 9th of every month by medical specialists.

Child Survival and Immunization Architectures

• Mission Indradhanush / Intensified Mission Indradhanush (IMI): A targeted immunization drive designed to capture unvaccinated and partially vaccinated children and pregnant women in low-coverage pockets, delivering protection against vaccine-preventable diseases.
• Rashtriya Bal Swasthya Karyakram (RBSK): An early intervention initiative involving systemic screening of children from birth to 18 years to track the “4 Ds”: Defects at birth, Deficiencies, Diseases, and Developmental delays.
• India Newborn Action Plan (INAP): Formulated with clear strategic goals to reduce preventable newborn deaths and stillbirths to single-digit targets by 2030.