Demography and the dual pattern

While national averages indicate progress, regional variations highlight different stages of development across India

The 2024 Sample Registration System report highlights a significant shift in India’s demographic journey. 

On a national scale, public health initiatives achieved steady progress over the last decade. Recent data shows the national birth rate dropped from 21 in 2014 to 18.3 in 2024. Simultaneously, the infant mortality rate — child deaths before age one per 1,000 live births — fell from 39 to 24, pointing to successful immunisation coverage and institutional deliveries.

However, a closer look reveals substantial differences in demographic profiles between regions. While national averages indicate progress, regional variations highlight different stages of development across the country. For instance, the infant mortality rate stands at 36 in Chhattisgarh, and 35 in both Madhya Pradesh and Uttar Pradesh. In contrast, Kerala records a rate of eight, followed by Tamil Nadu, Delhi, and Himachal Pradesh at 11, indicating that local health infrastructure and maternal support vary significantly.
This divergence is especially visible when comparing urban centres to rural areas. 

The report places the rural infant mortality rate at 27 per 1,000 live births, compared to 17 in urban centres, suggesting that remote regions face distinct logistical challenges in healthcare delivery, public awareness, and maternal nutrition.

But birth and mortality rates only tell half the story; the underlying map of fertility reveals a deeper divergence. The national Total Fertility Rate — the average number of children born per woman — has remained stable at 1.9 for five consecutive years, falling below the standard population replacement level of 2.1. Statistically, this stabilisation is not uniform. Economically advanced areas report very low rates, with Delhi at 1.2, followed by Kerala, Tamil Nadu, and West Bengal at 1.3.

With nearly 10% of India’s population now aged 60 and older, these regions are transitioning into older demographic profiles. On the other hand, Bihar maintains the highest fertility rate at 2.9, indicating a youthful and growing population.

This dual pattern mirrors global trends, essentially making India a microcosm of the modern demographic world. Currently, approximately 71% of the global population lives in countries with fertility rates below the replacement level. Looking at East Asia, countries experience sharp demographic declines; South Korea records a fertility rate of 0.72, while China and Japan face shrinking workforces, impacting their domestic economies. 

Similar trends are visible across Europe, where nations like Italy face declining birth rates, and the United States remains below replacement level at roughly 1.58.

The shift towards lower fertility rates globally is linked to urbanisation and economic development. In major cities, the high cost of housing and living presents a practical challenge for expanding families. Furthermore, higher educational attainment and career opportunities for women lead to delayed marriage and childbearing. When combined with rising costs of childcare, these socioeconomic factors naturally lead to smaller family sizes.

As a result, an ageing demographic profile introduces distinct economic structural challenges. With fewer young workers entering the labour force, public pension and healthcare systems face increased fiscal pressure to support retired populations. Developed nations are adapting to these labour shortages by raising statutory retirement ages, investing heavily in automation and artificial intelligence.

To bridge these widening regional gaps, we can learn from successful home-grown blueprints. For instance, Tamil Nadu has mastered medical logistics through a transparent, automated supply system that keeps even remote rural clinics fully stocked with free, high-quality medicines. Emulating this approach can directly help high-mortality regions upgrade healthcare delivery swiftly.

Similarly, Kerala’s focus on decentralised governance — where local communities receive direct funding to manage their own health and social safety nets — offers a powerful lesson in building resilient
systems for an ageing population. By putting resources directly into the hands of local councils, states can better address the unique day-to-day needs of citizens.

By applying these lessons, development resources can be targeted towards rural districts in states with higher infant mortality rates, focusing on local clinics, clean water supply, and maternal nutrition. Simultaneously, states with older demographic profiles, such as Kerala, Tamil Nadu, and West Bengal, can continue developing healthcare and social security frameworks tailored specifically for senior citizens.

Meanwhile, states with youthful populations like Bihar can focus on quality education, technical training, and employment generation, allowing the expanding workforce to contribute productively to the national economy.

To make this cross-regional economic engine work, implementing portable social benefits and supportive integration frameworks for migrating workforces will be vital. Finally, continuing to expand female literacy and reproductive healthcare nationwide remains essential, as these factors consistently support child survival and balanced family planning.

(The author is an independent writer) 

Disclaimer: The views expressed above are the author's own. They do not necessarily reflect the views of DH.