“Whatever you can rightly say about India, the opposite is also true.” The old Joan Robinson line still works because India has a way of defeating neat summaries. Most national averages come with broad patterns, outliers and warnings.The latest Sample Registration System data is one such mirror. The SRS, India’s official large-scale system for tracking births and deaths, gives annual estimates of fertility and mortality. At first glance, the headline number is simple: India’s fertility has fallen below replacement level. But a closer look shows a more uneven country. Some of India is already in low-fertility territory. Some of it is still above replacement. Cities are largely pulling fertility down, but urban Bihar is not following the script. Families are having fewer higher-order births, but the social consequences of smaller families are only beginning. Fewer infants are dying, but the first week of life remains the danger zone. And while birth is now overwhelmingly inside the hospital system, death is not.For years, the policy conversation moved between two extremes, fear of too many births and celebration of a young workforce. A young population can become a dividend only when it is properly trained and empowered. A low-fertility population, meanwhile, brings its own demands, such as pensions, elderly care, chronic-disease treatment and migration planning. Both have challenges of their own.We look at five data points from SRS data which highlights various such issues.
The average hides the worry
India’s Total Fertility Rate, or TFR, is now 1.9. TFR means the average number of children a woman is expected to have over her lifetime, based on current fertility rates. In 2014, India’s TFR was 2.3. Rural India has moved from 2.5 to 2.1. Urban India has gone from 1.8 to 1.5. In demographic language, India is below replacement fertility. In plain language, the baby boom is over.But the national average is only the beginning. Bihar is still at 2.9. Uttar Pradesh is at 2.6. Madhya Pradesh is at 2.4. Rajasthan is at 2.3. Chhattisgarh and Jharkhand are at 2.2 each. Delhi, a city-state, sits at the other end of the spectrum at 1.2. The World Bank has warned that South Asia is not creating enough jobs to keep pace with its working-age population, especially for youth and women. When above-replacement fertility is concentrated in some of India’s poorer states, the policy challenge is obvious.
The Bihar exception
The second figure comes from urban India, where one outlier stands out. The general assumption is that once people move to a city, families become smaller as parents want to invest more in fewer children. Across India, that broad story holds. Urban India’s average General Fertility Rate, or GFR, fell from 61.2 births per 1,000 women aged 15-49 in 2012-14 to 51.0 in 2022-24. GFR measures the number of live births in a year per 1,000 women in the reproductive age group of 15-49. Here, live births means babies born alive, which is the base used for fertility and mortality calculations.But Bihar breaks the pattern. Urban Bihar’s average GFR rose from 75.9 to 77.5 in the same period. The single-year figure makes the gap even clearer. In 2024, urban Bihar’s GFR was 80.3, against 49.8 for urban India.
The birth ladder is thinning
The third shift is less startling, yet perhaps the most significant. In 2014, first-born children made up 43% of live births in India. By 2024, they made up 66.4%. Third-and-higher-order births fell from 25.9% to 10.8%. Fourth-or-higher births fell from 10.8% to 3.5%.It does not mean every family is stopping at one or two children. It means the births happening now are increasingly first and second births. The old ladder, third child, fourth child, fifth child, is thinning. That is a bigger social change than it may first appear. Fewer children mean parents invest more in each child. Education becomes a heavier bet. The implicit assumption that children will automatically become old-age security for parents also begins to weaken.
The first week remains the concern
The fourth number is about survival. Here, India has made real progress.Infant mortality fell from 39 deaths per 1,000 live births in 2014 to 24 in 2024. Infant Mortality Rate, or IMR, means the number of deaths of children below one year of age per 1,000 live births. Rural IMR fell from 43 to 27. Urban IMR fell from 26 to 17. Under-five mortality fell from 45 to 28. Under-five mortality rate, or U5MR, means deaths before age five per 1,000 live births. These are not mere statistics. They mean children who would once have died are now alive.But the first week remains the most worrying part.
In 2014, 52% of infant deaths occurred in the first week. In 2024, it was 52.7%. It means that, among infants who die before turning one, more than half die in the first week. India has reduced infant mortality, but the deaths that remain are still clustered close to birth. The World Health Organization says the first month of life is the most vulnerable period for child survival. UNICEF describes the first 28 days, known as the neonatal period, as the most vulnerable time for a child’s survival. India’s data fits that global warning.
Hospitals see birth, miss death
The fifth number is the most haunting. It is about how many deaths remain unattended. At birth, the system is now present. In 2014, 78.5% of live births received delivery care in government or private hospitals. By 2024, that had risen to 95.4%. Government hospitals drove much of the rise, from 52% of deliveries to 71.7%.At death, the system is far less visible. In 2014, 42.6% of deaths had medical attention before death in government or private hospitals. In 2024, the figure was 40.2%. The category of “untrained functionary, no medical attention and others” rose from 22.4% to 45.5%.A child is now far more likely to be born under hospital supervision than a person is to die after hospital attention. WHO’s civil-registration framework says information on births, deaths and causes of death is central to public-health planning. If death happens outside formal care, the system may miss not only the person but also the cause.As India moves into its next phase of growth as one of the world’s largest economies, several issues will need high-level of focus. SRS, like all good data, is only a reflection. What India chooses to see in it will decide what comes next. Go to Source
