India’s fertility journey has moved from crisis to choice?
S Irudaya Rajan and Andrea M. Wojnar write:
Driving the conversation towards reproductive autonomy—the fundamental right of individuals to make independent choices about their bodies and reproductive futures—and demographic resilience, the United Nations Population Fund’s (UNFPA) flagship 2025 State of World Population Report, Real Fertility Crisis, provides crucial insights into human fertility worldwide. An online poll conducted across 14 countries, including India, as part of the report by UNFPA and YouGov, reveals new evidence on reproductive barriers and the lingering tension between aspirational and realised fertility.
India’s families are changing. A few decades ago, it was common for women to have five children. Today, that number has dropped to around two. The country’s total fertility rate (TFR) now stands at 2.0, down from 2.9 in 2005. This shift is not accidental. People are living longer, fewer are dying young, and many families are having fewer children. Yet, due to a large youth population and rising life expectancy, India’s population is still growing and will peak later this century. However, the picture is not the same everywhere. India’s states show wide variations. In Bihar, for example, the average number of children per woman is still 3.0. Meghalaya is close behind at 2.9. Jharkhand and Uttar Pradesh each stand at 2.3 and Manipur at 2.2—all above the replacement level of 2.1. One area of concern is adolescent fertility. While progress has been made, many girls are still becoming mothers far too early. India’s adolescent fertility rate is 14.1 per 1,000 girls aged 15 to 19—higher than China (6.6), Sri Lanka (7.3), or Thailand (8.3). Early motherhood can put both young mothers and their babies at risk and often means missing out on education or job opportunities.
Often, there is a strong tendency for conversation around demography to focus on “fertility crises”—fears of shrinking populations and its fallout for economies. But what if the wrong questions were being asked all along? The report challenges this narrow lens and shifts the focus from numbers to people. It offers a human-centred perspective by spotlighting the lived realities of individuals with unmet reproductive aspirations. The real fertility crisis is not about declining birth rates, but about the barriers that prevent people from having the number of children they want, whether that means achieving a pregnancy or avoiding one. Behind the numbers, there is a quieter story of choices and missed chances.
While India’s fertility rate has come down, the gap between the number of children people have and the number they actually want to have remains significant. Data from the National Family Health Survey 2019–21 in India brings this into focus. It shows a clear gap between the TFR and the total wanted fertility rate—what the rate would be if all unwanted pregnancies were avoided. That gap is the widest in high-fertility states like Bihar, Meghalaya, and Jharkhand. The UNFPA–YouGov poll offers deeper insights into the aspirations and realities of people’s reproductive lives. Among Indian respondents, 36% had experienced an unintended pregnancy. On the other side of the spectrum, 30% reported being unable to have the children they wanted. For nearly one in four people—23%—both were true at some point in their lives. And it is not only about access but also about choice. More than a quarter of women (27%) and a third of men (34%) could not use the contraceptive method they preferred.
When it comes to the ideal family size, the story is strikingly consistent. Across India, most people—41% of women and 33% of men—prefer two children. Only a small share prefers one, and even fewer want more than three. However, wanting children and being able to make it possible are two very different aspects. Economic pressure was found to be the biggest reason people were not having the families they wanted. Almost 4 in 10 respondents cited financial constraints. Others pointed to housing struggles, job insecurity, or the lack of affordable childcare. Health issues added another layer. Poor general health, chronic illness, and infertility were major barriers.
The World Health Organization estimates that infertility affects anywhere from 3.9% to 16.8% of India’s population. It is a topic still wrapped in silence and stigma—especially in a society where having children is closely linked to marriage, identity, and social acceptance. Even for those seeking help, options are limited. Fertility treatments are expensive, largely unregulated, and concentrated in private clinics. And in a system where sterilisation is still the most common form of contraception, many are left without room to change their minds later. Pressure from healthcare providers also stands in the way of reproductive choice—14% of Indian respondents faced, or would expect to face, pressure from doctors or health workers to have fewer children than they actually wanted.
Infertility, which affects an estimated 27.5 million Indian couples, remains a neglected dimension of reproductive health policy. Public sector support is limited, private care is expensive and concentrated in urban areas, and social stigma still falls on women, although infertility affects all genders. Integrating infertility services into public health insurance schemes and expanding equitable access are necessary steps towards inclusive reproductive healthcare.
India’s Family Planning 2030 vision promotes universal access to quality reproductive health services. As fertility behaviours change, policies must support individuals in meeting their reproductive goals—not impose outcomes. This means expanding contraceptive choices, supporting healthy pregnancy spacing, and improving postpartum access. While social and economic barriers are slower to shift, India’s strong track record positions it well to further advance service delivery. By addressing systemic barriers of all types and enabling people to achieve their fertility goals, India can lead the way towards a more just and resilient demographic future.
