Opinion Health indicators point to gains on infant mortality, total fertility rate but large disparities remain
Read together, the data does not present a single India on the cusp of its demographic dividend, but two demographic realities moving at different speeds
The fertility data, too, compounds this picture of two Indias. India’s Total Fertility Rate (TFR) has remained flat at 1.9 for the fifth consecutive year, below the replacement level of 2.1. The just-released Sample Registration System report for 2024 highlights a demographic transformation that is cause for both celebration and concern. The country’s birth rate — the total number of live births per 1,000 people in a population — declined to 18.3 per 1,000 population in 2024, down from 21 in 2014.
The Infant Mortality Rate (IMR) has also fallen steadily from 39 per 1,000 live births in 2014-2019 to 24 in 2024. These gains reflect decades of sustained public-health investment. Yet, the national averages conceal a deeper gulf between rural and urban areas, and between states: Chhattisgarh records the country’s highest IMR at 36, with MP and UP at 35 each. Kerala, at the other end, stands at eight; Tamil Nadu, Delhi and Himachal Pradesh at 11. This gap between the best- and worst-performing states underlines persistent local failures.
The broader gains reflected in the data owe much to the cumulative impact of targeted interventions under the National Health Mission. These have expanded immunisation coverage, lowering preventable child deaths, and improved institutional deliveries. But the persistence of rural disadvantage suggests that public-health infrastructure has advanced unevenly, with poorer states and districts still struggling to catch up. The 2024 data places rural IMR at 27 deaths per 1,000 live births, compared with 17 in urban areas — a disparity that reflects enduring inequalities in healthcare access, awareness and maternal nutrition.
The fertility data, too, compounds this picture of two Indias. India’s Total Fertility Rate (TFR) has remained flat at 1.9 for the fifth consecutive year, below the replacement level of 2.1. Delhi records the country’s lowest TFR at 1.2, followed by Kerala, Tamil Nadu, and West Bengal at 1.3. But Bihar’s TFR remains the highest at 2.9. The consequences of ignoring this are considerable. Nearly 10 per cent of India’s population is now aged 60 and above, signalling that many of the economically advanced states are ageing rapidly. Read together, the data does not present a single India on the cusp of its demographic dividend, but two demographic realities moving at different speeds. Policymakers must resist the comfort of national averages to confront that divergent reality.
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