With TFR at 1.9, EAC-PM calls for end to sterilisation incentives

India's TFR has fallen to 1.9, below replacement level. The EAC-PM has called for ending sterilisation-linked incentives and reviewing population-control rules in low-fertility states

The Economic Advisory Council to the Prime Minister (EAC-PM) has recommended ending financial incentives linked to sterilisation and rolling back population-control rules, saying India’s fertility has fallen well below replacement levels and family-planning policies need to reflect the country’s new demographic reality.

 

In a working paper titled The Ghost of Population Past: How Population Control Persists in India, the EAC-PM said India’s total fertility rate (TFR) was 1.9 in 2024, based on Sample Registration System (SRS) data. The National Family Health Survey-6 puts the figure at 2.0.

 

The paper said the national TFR is now below replacement fertility. Excluding Bihar and Uttar Pradesh, the TFR falls to 1.6, comparable with Northern Europe at 1.5 and the US at 1.6.

 

 

The EAC-PM said the continued focus on reducing fertility reflects an outdated concern about population growth, while the country is increasingly facing the opposite challenge in several states -- low fertility and an ageing population.

 

Why does EAC-PM want sterilisation incentives withdrawn?

 

The paper recommended rolling back all direct benefit transfer (DBT) payments related to sterilisation, including compensation paid to people undergoing the procedure, wage-loss compensation and enhanced incentives for acceptors and service providers.

 

“Roll-back all direct benefit transfer payments, including acceptor payments, wage-loss compensations, and enhanced incentives to acceptors and service providers, related to sterilisations,” the report said.

 

The EAC-PM said sterilisation services can continue to be provided without financial incentives to encourage people to adopt them. It said there was no economic rationale for retaining these incentives in states where fertility is already below replacement levels.

 

It also recommended eliminating motivational payments linked to terminal methods and the ASHA incentive related to limiting couples to two children. Terminal methods refer to permanent forms of contraception — female sterilisation or tubectomy and male sterilisation, including non-scalpel vasectomy. Reversible methods include condoms, oral contraceptive pills, intrauterine contraceptive devices (IUCDs) and injectable contraception.

 

Why does 80% of the incentive allocation go to sterilisation?

 

The report highlighted what it described as a mismatch in the existing incentive structure. The National Family Planning Programme provides several payments, including compensation for those accepting sterilisation, motivation payments to Accredited Social Health Activists (ASHAs) who mobilise people for the procedure and payments to service providers.

 

According to the EAC-PM, terminal methods receive substantially higher incentives than reversible methods. In Mission Parivar Vikas states, incentives for terminal methods can be up to 10 times those for reversible methods such as IUCDs and injectable contraception.

 

At the national level, about 80 per cent of all fiscal allocations for incentives and compensation go towards sterilisation, the paper said.

 

It said this structure remains in place even in states where fertility has already fallen below replacement.

 

It cited Gujarat as one example. The state, which has been below replacement fertility for a decade, budgeted ₹12 crore for ASHA incentives to motivate 120,000 clients to adopt terminal methods in 2026-27.

 

Similar incentives continue in West Bengal and Punjab, which have been below replacement fertility for more than two decades.

 

How much have India’s annual births fallen since 2001?

 

The EAC-PM said India’s demographic situation has changed sharply over the past two decades.

 

Annual births peaked at about 29.3 million in 2001. By 2023, they had fallen to around 23.2 million, a decline of about one-fifth.

 

The report said the number of annual births is now around the same level as in 1974, despite India’s population having increased significantly since then.

 

The paper said India’s population is still growing because of its relatively young population and the resulting population momentum. Improvements in healthcare and living standards have also reduced infant mortality and increased life expectancy.

 

This means a falling fertility rate does not immediately translate into a falling population. A large young population can continue to produce a sizeable number of births even when each woman has fewer children on average.

 

Which states are already facing low fertility?

 

The fall in fertility is much sharper in several southern and western states. The EAC-PM said Andhra Pradesh has a TFR of 1.4, Telangana 1.5, Karnataka 1.5, Kerala 1.3 and Tamil Nadu 1.3.

 

West Bengal has a TFR of 1.3, while Punjab and Maharashtra are at 1.4 each. Goa has a TFR of 1.6, Himachal Pradesh 1.5, Sikkim 1.0 and Delhi 1.2.

 

These states have been below replacement fertility for more than two decades. Their median age is close to 35 years, compared with around 30 years for India as a whole. The EAC-PM said their demographic profile is, therefore, closer to ageing economies such as the US, where the median age is about 39 years.

 

At the same time, fertility remains higher in states such as Bihar and Uttar Pradesh. This means India is experiencing different demographic realities across states, with some already dealing with low fertility and ageing while others still have relatively young and fast-growing populations.

 

Why does EAC-PM want two-child rules repealed?

 

The EAC-PM has recommended repealing two-child rules across all states. Such rules can bar people from government benefits, jobs or contesting local elections, depending on the law.

 

It also suggested withdrawing population-control-related incentives and practices, including awards linked to family planning, World Population Day events and Vasectomy Fortnight.

 

The council recommended removing terms such as “population control” and “fertility reduction” from policy documents. However, it clarified that it is not against family planning or contraception. It supports these for health, birth spacing and personal choice.

 

The council said policies should allow fertility to follow its natural course, especially in states where it is already below replacement levels.