How India’s health profile has changed over the last four years, explained in 5 charts

IN THE SPRAWLING slum in Delhi where Parul Gayen lived in the 1970s, children were everywhere. It was not unusual then that her mother had been one of six, or her grandfather one of 11. Swapan, the handsome boy whom she often saw cycling to work, and later married at 16, had six siblings—the seventh did not survive infancy. But times have changed, says Ms Gayen, who is now 58 and lives with Swapan in a one-bedroom flat nearby. Of the couple’s three grown-up kids, only two decided to have children of their own. Both stopped at one. “One child feels lonely,” she says.In 1950 India’s population was 360m. The average woman had six children—roughly the same as an American woman a century earlier. Today, with a population of 1.45bn, India accounts for a sixth of humanity. It surpassed China as the world’s most populous country in 2023 and has kept growing. But its total fertility rate (TFR), the number of births a typical woman has over her lifetime, has fallen to 1.9 (see chart 1), below the level needed to keep the population stable in the long run. Although the population will keep growing for a spell, as the generation that are currently children themselves become parents, a future contraction is inevitable unless the fertility rate rises back above 2.15. In practice, it is likely to keep falling, accelerating the impending shrinkage. In Delhi, for instance, the TFR is 1.2.Baby bluesThe rich world and many middle-income countries are awash with anxiety about declining fertility, shrinking workforces and impending or intensifying falls in population. Politicians often badger or bribe parents to have more children, with little success. Now India, once a source of angst about exponential population growth, is joining the same club. New school textbooks, to be published this summer, will warn of the perils of too few, rather than too many, children. In May Chandrababu Naidu, the chief minister of Andhra Pradesh, a southern state of about 55m, announced a 30,000 rupee ($315) payout for couples who have a third child.As recently as 2019 Narendra Modi, the prime minister, warned of a “population explosion”. But the government’s thinking has flipped, says Sanjeev Sanyal, an adviser to Mr Modi. Today officials worry that India is on a similar path to China, whose population has been shrinking since 2021. Fertility has fallen much further and faster than expected, says Neelkanth Mishra, chief economist of Axis Bank. In both Tamil Nadu, a state of roughly 77m, and West Bengal (100m) the TFR stands at 1.3, the same as in Finland (see chart 2). The average for urban India is 1.5. For a long time demographers thought poor northern states would delay India’s demographic transition. Now they seem to be converging with wealthier, less teeming parts of the country.Some might see a shrinking population as a blessing. After all, India’s infrastructure often seems inadequate: think of commuters cramming themselves into Mumbai’s local trains, for instance. Yet the prospect of an India with fewer children is not an entirely comforting one, either. It would get old before it gets rich, making for a difficult demographic transition. The effects would ripple through its society, its economy and its politics.India’s extraordinarily fertile land and largely reliable monsoon help explain why it accounts for 2.4% of the world’s land mass but 18% of its people. Its population was given a further boost by the medical advances of the late 20th century. In 1950 a quarter of children did not survive to their fifth birthday; by 2000 only a tenth died young. India went through this transition in mortality at an unusually early stage of development, when its birth rates remained very high, says Sonalde Desai of the University of Maryland.That combination made India exhibit A for population alarmists. It was a visit to a “hellish” slum in Delhi in the 1960s that inspired Paul Ehrlich, an American biologist, to write “The Population Bomb”. He warned that the battle to