India’s low-fertility states face limits and prospects in fertility recovery

India has officially crossed a demographic threshold that once seemed decades away. According to the National Family Health Survey conducted between 2019 and 2021, the country’s total fertility rate now stands at 2.0 children per woman, below the 2.1 replacement level, and 23 of India’s states have fertility rates beneath that critical benchmark. As several state governments, notably Andhra Pradesh with its draft population management policy, begin debating incentives to encourage larger families, a new study published in the Journal of Population Research delivers a sobering quantitative message: the demographic room for a fertility rebound among currently married women is far smaller than policymakers may assume, because a large share of India’s reproductive capacity has been permanently removed.

The research, led by Saseendran Pallikadavath of SRM University Andhra Pradesh together with Mohammad Mahbubur Rahman of the University of Salford and Kumar Ch. Satish, introduces a conceptual framework that goes beyond the fertility intentions that have dominated previous studies of low fertility. The authors argue that whether fertility can recover depends not only on how many children women say they want, but on who is still physiologically and behaviourally exposed to childbearing at all. To capture this, the study distinguishes three populations within the married female population of reproductive age. The first is the “limitation stock,” comprising women who have permanently exited childbearing through sterilisation, hysterectomy or infecundity. The second is the “prospect stock,” women who remain exposed to the possibility of pregnancy. The third, and most policy-relevant, is the “recovery prospect”: women who are still exposed and who also report wanting another child.

The numbers drawn from the 23 below-replacement states reveal why the authors describe recovery prospects as inherently limited. Across these states, the limitation stock accounts for 47.4 percent of currently married women of reproductive age, and the overwhelming component of this figure is female sterilisation, which alone contributes 43.8 percentage points. In other words, nearly half of all married women in India’s low-fertility states can no longer have children, and the great majority of them reached that state through tubal ligation, a procedure that is effectively irreversible. Hysterectomy and natural infecundity, including early menopause, make up the remainder. This pattern reflects decades of an Indian family planning programme that has historically relied on female sterilisation as its dominant method, often targeting women at young ages shortly after they achieve their desired family size.

Yet even among the 52.6 percent of married women who remain exposed to childbearing, enthusiasm for additional children is far from universal. Only 41.3 percent of these women say they wish to have another child. Multiplying these two figures yields the study’s central quantity: just 21.7 percent of currently married women constitute the immediate recovery prospect, being both outside the limitation stock and desiring another birth. The arithmetic is straightforward but its implications are stark. If every one of these women had exactly one additional child, the pooled total fertility rate across the 23 states would rise from 1.79 to just 1.96, still shy of the 2.1 replacement threshold.

The technical machinery behind these estimates deserves attention because it clarifies what the numbers mean. The recovery prospect for each state is calculated as the product of the prospect stock, the share of married women not in the limitation stock, and the want-share, the proportion of that remaining group who want another child. To convert extra births among married women into a fertility rate defined per woman aged 15 to 49, the researchers weight by the proportion of women in each state who are currently married, a substantial factor in India where marriage remains nearly universal. Age-specific fertility rates were computed by dividing births recorded over the survey’s three-year recall window by three to annualise them, and the total fertility rate was obtained by summing rates across five-year age bands, each band rate multiplied by five, the width of the age interval, to recover the area under the age-specific fertility curve.

The study also tested the more modest policy lever of delaying sterilisation, the idea being that if women postponed tubal ligation by even a year or two after their last birth, some additional pregnancies would occur in the interval. The result was almost negligible: delaying one-child sterilisation would add only 0.011 children per woman to the total fertility rate. This finding directly challenges the assumption that tinkering with the timing of sterilisation, without changing the underlying method mix, can meaningfully raise fertility. Once the programme’s reliance on early, permanent contraception is entrenched, the window for behaviour-driven recovery narrows to almost nothing.

Perhaps the most striking counterfactual in the paper concerns marriage itself. Unlike Europe, where low fertility coexists with widespread childbearing outside marriage and prolonged singlehood, India’s fertility transition has unfolded within a context of near-universal and relatively early marriage. This means that a substantial fraction of reproductive-age women, those who have never married, are largely invisible to conventional fertility measures. The researchers calculated that if never-married women aged 20 to 49 experienced the same age-specific fertility rates as currently married women, the total fertility rate would jump by an additional 0.52 children per woman, reaching 2.48, comfortably above replacement. While this is a hypothetical calculation rather than a policy recommendation, it illuminates where the genuine demographic flexibility lies: in the composition of the young, unmarried population whose marriage timing and childbearing trajectories are still undecided.

Taken together, these findings suggest that the future of Indian fertility will be determined far more by younger cohorts who have not yet married than by any intervention aimed at currently married women, whose remaining capacity is either already committed, already extinguished, or already subject to unmet desire for fewer children. The authors are careful to frame this as an implication rather than an estimated causal effect, but the policy direction they sketch is clear. Rather than cash incentives for third births, which in the Indian context risk coercing women who have completed their families, governments might achieve more by supporting family formation among young adults, widening access to reversible contraception so that women can space births without foreclosing them, and gradually reducing the programme’s historical dependence on female sterilisation as the default terminal method.

The research also speaks to an international literature on the limits of pro-natalist policy. Comparative evidence from Europe and East Asia, where countries such as Japan, South Korea and Italy have deployed generous family allowances, parental leave and childcare subsidies for decades, suggests that such measures rarely restore replacement-level fertility on their own. India’s situation adds a distinctive twist: in high-income settings, low fertility reflects postponement and changing preferences among women who remain fecund, whereas in India it reflects the physical removal of reproductive capacity at scale. A policy toolkit designed for the former problem may simply not apply to the latter. The Indian case demonstrates that once sterilisation has been performed, no financial incentive, however large, can recover the foregone births.

The stakes of getting this analysis right are considerable. Projections such as those from the Global Burden of Disease study published in The Lancet anticipate that India’s population will peak and then decline within the coming decades, bringing population ageing, shrinking workforces and rising dependency ratios. States that pioneered fertility decline, particularly in southern India, where female education and health outcomes are comparatively strong, will face these pressures first and most acutely. Yet the new study implies that the demographic die has largely been cast for the current generation of married women. Any meaningful course correction must operate upstream, through education, employment opportunities for young women, and a contraceptive culture that preserves choice rather than closing it off. In a country where sterilisation regret is well documented, and where early sterilisation has been shown to interact with women’s education and skill development, the argument for reversible methods is not merely demographic but a matter of reproductive autonomy.

What the study ultimately offers is a rare piece of quantitative honesty in a debate often dominated by alarm and simplistic fixes. By decomposing the married female population into those who can no longer bear children, those who can but do not wish to, and those who both can and do wish to, the researchers have replaced vague hopes of a fertility rebound with a precise accounting of its ceiling. That ceiling, at roughly two children per woman under the most generous assumptions, sits below replacement. The genuine reservoir of future fertility lies not in the marriages of today but in the life courses of the young women who will form the families of the next two decades, and how India treats their choices, in education, employment, marriage timing and contraception, will determine whether the country’s demographic future is managed by design or left to chance.