Dr Harish Kumar
Dr. Harish, a Public Health Pediatrician with over 40 years of experience, has worked with the Government, UN, and development partners. He has served as an intensivist, contributed to 30+ national guidelines, authored 40+ scientific publications, and provided strategic guidance to key projects like USAID’s SAMVEG and Vriddhi, and Norway-supported NIPI. He brings deep expertise in Health Systems Strengthening, Government Partnerships, and innovation, playing a key role in initiatives like Newer Pneumonia Diagnostics, Family Participatory Care, and evidence-based health planning.
Every year, World Population Day offers us a moment to pause, reflect, and act on critical issues related to population dynamics. In a country as vast and diverse as India, this day is not only symbolic—it is a call to realign our policies with the lived realities of over 1.4 billion people. With fertility rates stabilising in some regions, declining in others, and persistently high in a few more, and poverty entrenched in specific geographies, the call for an evidence-based, geographically targeted implementation strategy is the need of the hour.
Hence, this year, we propose a shift from generic, one-size-fits-all population strategies to a geography-sensitive, evidence-based implementation and planning approach. This helps deep-dive into India’s demographic transitions, socio-economic and health inequities and zoom in on populations that require immediate attention and targeted interventions.
India is not one demographic story but many.
The UN Population Fund’s (UNFPA) 2025 State of the World Population report states that the Total Fertility Rate (TFR) for India has dropped below the replacement level to 2.0, indicating that, on average, Indian women are having fewer than two children. The report, “Real Fertility Crisis,” argues that women continue to face significant barriers to making free and informed decisions about their reproductive lives, and considerable disparities persist across regions and states.
States like Bihar (2.98), Uttar Pradesh (2.35), and Meghalaya (2.91) still report high fertility rates. In contrast, states such as Kerala (1.8), Tamil Nadu (1.7), and West Bengal (1.6) have long crossed into low fertility regimes.
Similarly, poverty levels, measured through Multidimensional Poverty Indices (MPI), also vary sharply. High MPI districts include many in Bihar, Jharkhand, Uttar Pradesh, Chhattisgarh, and Madhya Pradesh. Relatively lower poverty is found in southern and western India, with stronger economic indicators and access to services.
This uneven demographic and development landscape demands a new policy and program implementation model that uses geography as an organising principle for planning.
Why does evidence-based planning matter?
Current national and state-level programs often deploy uniform interventions in maternal health, assuming similar needs across districts. This approach usually risks under-serving high-burden districts, where young populations, unmet need for family planning, and socio-economic deprivation converge, and two, wasting resources in low-fertility districts, where other needs like geriatric care or chronic disease management may be more pressing.
An evidence-based geographical approach using spatial data, health indicators, and poverty maps can best identify clusters requiring tailored interventions, such as demographics with high fertility, early marriage, adolescent pregnancy, and poverty.
Demographic-specific evidence-based planning
In high-fertility, high-poverty districts like Bihar, Uttar Pradesh, and Jharkhand, the focus should be shifted to accelerating family planning awareness and access, delaying the age of marriage and childbirth, and improving adolescent reproductive health. Here, we propose interventions such as deploying mobile family planning clinics and youth counsellors in underserved blocks, integrating sexual and reproductive health (SRH) modules into campaigns, and training ASHAs and Auxilliary Nurse Midwives (ANMs) in culturally sensitive counselling. Besides, let us reiterate how investments in girls’ education and nutrition and linking health services with education and skill-building are also critical.
Coming to the second division, moderate-fertility, moderate-poverty districts such as Madhya Pradesh, Rajasthan, and Assam, must shift their focus to addressing the unmet need for modern contraceptives, ensuring quality antenatal and postnatal care, and preventing adolescent girls from dropping out of school. Key actions must include scaling up postpartum family planning in hospitals, streamlining contraceptive supply logistics, and digitally tracking pregnancies through tools like the ANMOL app.
Last, in low-fertility, low-poverty districts like Kerala, Tamil Nadu, and Maharashtra, the focus must turn towards managing an ageing population, avoiding over-medicalisation in reproductive health, and promoting male participation in family planning. This involves expanding geriatric care at the Primary Health Care (PHC) level, enhancing quality of reproductive health services, conducting behaviour change campaigns targeting men, and gradually reallocating resources to address Non-communicable Diseases (NCDs) alongside reproductive health efforts.
Building an Inclusive Evidence Base: Data and Equity
India’s robust data ecosystem can be a big support in building equitable health and development tools. National Family Health Survey (NFHS) offers detailed insights on fertility, family planning, and maternal-child health, while the Health Management Information System (HMIS) provides real-time public health service data. At the same time, the MPI identifies deprived areas, and the Aspirational Districts Dashboard tracks key performance indicators across sectors.
However, to truly ensure equitable progress, it is critical to apply an equity lens that identifies and prioritises the needs of the most marginalised within each geography. This includes scheduled castes and tribes, urban slum dwellers, migrants, women with disabilities, and adolescents who are outside a formal system, often facing intersecting barriers to access and opportunities.
By integrating data with participatory planning at the block and village levels, India can move closer to the Sustainable Development Goal commitment of “leaving no one behind.” This approach not only sharpens policy targeting but ensures that the most vulnerable population is visible, heard, and served.
A Call to Action
As we mark World Population Day 2025, India stands at a demographic crossroads—some states will age rapidly in the next decade, while others still face a youth bulge. Our policies must be evidence-based, data-driven, and inclusive to serve every reality. This World Population Day, let us pledge to invest in data, dialogue, and decentralised planning—because every district matters, every woman matters, and every life counts.
