India’s Total Fertility Rate has fallen below the replacement level for the first time, revealing a widening demographic divide between ageing southern states and younger northern states, according to the Sample Registration System Statistical Report 2024 published by the Office of the Registrar General and Census Commissioner, Ministry of Home Affairs, in May this year.
The national TFR declined to 1.9 in 2024 from nearly 4.6 in 1985. But the average conceals wide spatial contrasts. Bihar recorded the country’s highest fertility rate at 2.9, while Delhi stood at 1.2. Delhi also registered the sharpest decline over the past decade at 29.4%, while Bihar saw the slowest decline at 9.4%. The divide extends beyond fertility. Child survival rates remain deeply unequal across states. Under-five mortality stood at 41 in both Madhya Pradesh and Uttar Pradesh, compared to just 9 in Kerala. Geography continues to shape survival chances. Rural India recorded an under-five mortality rate of 32, against 19 in urban areas.
The report shows a broad decline in fertility levels across India between 2012–14 and 2022–24, measured through the General Fertility Rate (GFR), which tracks the number of births per 1,000 women aged 15–49. GFR fell from 78.8 to 64.6, a decline of 12%. Rural GFR dropped from 86.2 to 71.9, while urban GFR declined from 61.2 to 51.0. Delhi recorded the steepest decline. While the total GFR fell by 29.9%, urban Delhi saw an even sharper fall of 35.6%.
Tamil Nadu and Gujarat also showed major declines of over 24%. Bihar remained the highest at 96.0 in 2022–24, followed by Uttar Pradesh at 83.0 and Rajasthan at 82.7. Bihar also showed the slowest overall decline at just 8.9%. Urban GFR in Bihar increased slightly from 75.9 to 77.5, making it the only major state where urban fertility rose during the decade. Southern and western states now report some of the lowest fertility levels in the country. Kerala had a GFR of 42.9, while Tamil Nadu stood at 42.1.
The report revealed that more than half of infant deaths occur within the first week of birth. Early neonatal deaths accounted for 52.7% of all infant mortality, while 72.8% occurred within the first 28 days. Nearly 45.5% of all deaths in India occurred without qualified medical attention in 2024. The figure rose to 48.9% in rural areas. Only 40.2% of deaths took place in hospitals, either government or private. At the same time, institutional deliveries have expanded sharply over the decades, with 71.7% of births now taking place in government hospitals.
Nationally, 73.5% of women married at age 21 or above in 2024, while 24.5% married between 18 and 20 years. Only 2.1% married before 18. In urban areas, 82.2% of women married after 21, compared to 70.2% in rural India. Delhi recorded one of the latest marriage patterns in the country. No marriages below 18 were reported.
Kerala had an extremely low child marriage figure of 0.04%. Around 80.6% of women there married after 21. Tamil Nadu and Telangana showed similar patterns, especially in urban areas where more than four-fifths of women married after 21. West Bengal had the highest proportion of women marrying before 18 at 6.3%. Only 49.2% married after 21, making it the only major state where less than half of women crossed 21 before marriage. The rural situation was sharper. Nearly half of rural women in West Bengal married between 18 and 20, while 5.9% married before 18.
The report pointed to a rapidly ageing pattern. Kerala’s population aged 60 and above reached 15.1%, followed by Tamil Nadu at 14.2%. Bihar remained among the country’s youngest states, with nearly one-third of its population below the age of 14.
India’s sex ratio at birth stood at 918 girls per 1,000 boys between 2022 and 2024. Uttarakhand recorded the lowest ratio at 872, while Chhattisgarh and Kerala reported the highest figures at 978 and 974 respectively. The findings align with concerns raised in recent reports by the United Nations Population Fund over persistent regional disparities in health and demographic outcomes.
The 2024 SRS figures suggest that institutional medical care before death has expanded over time, but large gaps remain. In 2013, around 27% of deaths reportedly occurred without any medical attention, while 43% took place in institutions. By 2018, nearly 48% of deaths involved hospital-based care, reflecting a gradual rise in institutional access. The newer SRS series shows that progress has slowed. In 2020, about 45% of deaths still occurred without medical attention or with only untrained assistance. The 2024 figure remains almost unchanged at 45.5%.
Government hospitals continue to account for the largest share of medically attended deaths, at 24.7% in 2024, while private hospitals accounted for 15.5%. Qualified professionals outside hospitals accounted for another 14.3%.