Population Foundation urges shift from population control to informed choice, equity

New Delhi, The Population Foundation of India has called for moving beyond population control and focusing on informed choice, equity and demographic preparedness amid India's changing demographic reality.

The PFI welcomed the renewed attention to India's changing demographic reality following a recent paper by the Economic Advisory Council to the Prime Minister titled 'The Ghost of Population Past: How Population Control Persists in India'.

The paper makes an important point that India must move beyond the outdated language and policy logic of population control, the non-profit organisation said, noting that the country's total fertility rate is now below replacement level.

"India's fertility has already declined significantly, with the national total fertility rate now below replacement level," it said.

Many states, particularly in southern, western and parts of northern India, are already experiencing very low fertility and will need to plan for ageing, a shrinking younger population, care needs, migration and workforce changes, it said.

"At the same time, India's demographic transition remains deeply uneven," Poonam Muttreja, Executive Director at PFI, said.

"National averages hide significant differences across states, districts, income groups, rural and urban populations, and levels of education and access to health services," she said.

"Bihar, Uttar Pradesh and parts of central and eastern India continue to have a younger age structure and different development needs from states such as Kerala, Tamil Nadu, Punjab, West Bengal, Delhi and Himachal Pradesh."

Family planning must remain central to India's public health agenda, but not as an instrument of population reduction, the organisation said.

It said family planning must be understood as a matter of reproductive autonomy, birth spacing, maternal and child health, and access to quality services.

Even as fertility declines, unmet need for contraception, early marriage, adolescent health concerns, son preference, poor counselling and limited method choice remain important challenges in many parts of India, it said.

India's modern contraceptive prevalence rate has risen to 56.5 per cent, but the method mix remains overwhelmingly dominated by permanent methods, the PFI said.

Female sterilisation alone accounts for about two-thirds of the modern contraceptive method mix, while male sterilisation remains negligible, contributing less than 1 per cent, it said.

"This reflects not genuine choice, but a programme structure that has historically placed the burden of contraception disproportionately on women," the organisation said.

It said family planning budgets should increasingly support a broader basket of contraceptive choices, including condoms, oral contraceptive pills, injectables, IUCDs and other spacing methods, along with counselling and follow-up care.

"If incentives linked to sterilisation and target-driven family planning are phased out, this must be accompanied by a serious strengthening and regularisation of ASHAs, who remain central to last-mile counselling, trust-building and access to reproductive health services," it said.

"We cannot move from population control to informed choice while continuing to depend on underpaid frontline workers carrying the burden of programme delivery," the organisation said.

"India's policy response must avoid two mistakes: continuing with old population-control thinking on the one hand, and moving towards fertility panic or pronatalist pressure on the other," Muttreja said.

"The role of the state is not to push families to have fewer or more children. It is to ensure that every person, especially women and young people, has the information, services and freedom to make informed decisions about their lives," she said.

The PFI said India's demographic future should be guided by strengthening voluntary and rights-based family planning, rebalancing investments towards spacing methods and quality of care, and preparing states for the different demographic realities they now face.

"India's population debate must now shift from numbers to people. It should move from control to choice, from fear to preparedness, and from national averages to the lived realities of states, communities, women and young people," it said.

The EAC-PM recommended ending sterilisation-linked incentive payments in states as the national total fertility rate is now at 1.9, well below the replacement fertility rate.

In the working paper 'The Ghost of Population Past: How Population Control Persists in India', the EAC-PM also called for eliminating all motivational incentive payments tied to terminal methods and the ASHA incentive related to limiting couples to two children.

The national total fertility rate of India is 1.9, well below replacement fertility. Excluding Bihar and Uttar Pradesh, the TFR stands at 1.6. This is comparable to Northern Europe and the United States .

The paper also recommended discontinuing all family-planning-related awards, World Population Day celebrations and Vasectomy Fortnight observances that call for population control.

"In addition, repeal two-child norm disqualifications across all states," it said.

The EAC-PM also called for adjusting the scope of Mission Parivar Vikas to the new demographic reality in the states, which are at or below replacement fertility.

"Remove all fertility reduction, population control or 'stabilisation' language from our national and state policy frameworks and outputs," the paper said.

The annual number of births in India peaked at roughly 29.3 million in 2001. It has reduced by one-fifth since then to about 23.2 million births in 2023. At the current juncture, India is at the same level of births it had about 50 years ago, in 1974.

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