Health indicators point to gains on infant mortality, total fertility rate but large disparities remain

The just-released Sample Registration System report for 2024 highlights a demographic transformation that is cause for both celebration and concern. The country’s birth rate — the total number of live births per 1,000 people in a population — declined to 18.3 per 1,000 population in 2024, down from 21 in 2014. The Infant Mortality Rate (IMR) has also fallen steadily from 39 per 1,000 live births in 2014-2019 to 24 in 2024. These gains reflect decades of sustained public-health investment. Yet, the national averages conceal a deeper gulf between rural and urban areas, and between states: Chhattisgarh records the country’s highest IMR at 36, with MP and UP at 35 each. Kerala, at the other end, stands at eight; Tamil Nadu, Delhi and Himachal Pradesh at 11. This gap between the best- and worst-performing states underlines persistent local failures.

The broader gains reflected in the data owe much to the cumulative impact of targeted interventions under the National Health Mission. These have expanded immunisation coverage, lowering preventable child deaths, and improved institutional deliveries. But the persistence of rural disadvantage suggests that public-health infrastructure has advanced unevenly, with poorer states and districts still struggling to catch up. The 2024 data places rural IMR at 27 deaths per 1,000 live births, compared with 17 in urban areas — a disparity that reflects enduring inequalities in healthcare access, awareness and maternal nutrition.

The fertility data, too, compounds this picture of two Indias. India’s Total Fertility Rate (TFR) has remained flat at 1.9 for the fifth consecutive year, below the replacement level of 2.1. Delhi records the country’s lowest TFR at 1.2, followed by Kerala, Tamil Nadu, and West Bengal at 1.3. But Bihar’s TFR remains the highest at 2.9. The consequences of ignoring this are considerable. Nearly 10 per cent of India’s population is now aged 60 and above, signalling that many of the economically advanced states are ageing rapidly. Read together, the data does not present a single India on the cusp of its demographic dividend, but two demographic realities moving at different speeds. Policymakers must resist the comfort of national averages to confront that divergent reality.

Overall Analysis

The editorial analyses India’s latest demographic data from the Sample Registration System report and argues that while the country has made impressive progress in public health and population control, these achievements are highly uneven across regions. The central idea is that India is not experiencing one uniform demographic transition, but rather “two Indias” moving at different developmental speeds.

The article begins on a balanced note, describing the fall in birth rates and infant mortality rates as achievements resulting from long-term investments in healthcare. The language is factual and data-driven, using statistics to establish credibility. However, the phrase “cause for both celebration and concern” immediately signals that the editorial will move beyond national averages to expose hidden inequalities. By contrasting states like Chhattisgarh, Madhya Pradesh, and Uttar Pradesh with Kerala and Tamil Nadu, the writer highlights the stark disparity in healthcare outcomes. This comparison strengthens the argument that progress has not been equally distributed.

The second paragraph attributes improvements to initiatives under the National Health Mission, particularly in immunisation and institutional deliveries. At the same time, the editorial criticises the uneven development of healthcare infrastructure, especially in rural India. The contrast between rural and urban Infant Mortality Rates is used to reveal structural inequalities in healthcare access, awareness, and maternal nutrition. The language here becomes more analytical and policy-oriented, focusing on systemic shortcomings rather than isolated failures.

In the final section, the discussion shifts to fertility trends and ageing populations. The editorial points out that India’s Total Fertility Rate has fallen below replacement level in many developed states, while states like Bihar continue to record much higher fertility rates. This creates a demographic imbalance where some regions face ageing populations while others still struggle with population pressure. The phrase “two demographic realities moving at different speeds” is particularly powerful because it captures the uneven nature of India’s socio-economic transformation.

Overall, the editorial combines statistical evidence with policy analysis to argue that policymakers must look beyond national averages and address regional disparities directly. The writing style is formal, analytical, and cautionary, urging targeted intervention rather than complacency over aggregate progress.

Important Vocabulary (5)

1. Demographic – related to the structure and characteristics of populations.
2. Sustained – continued steadily over a long period.
3. Disparity – a major difference or inequality.
4. Replacement Level – the fertility rate needed to maintain a stable population size.
5. Cusp – the point at which an important change is about to happen.

Conclusion & Tone

The editorial acknowledges India’s success in reducing birth rates and infant mortality but warns that deep regional and rural-urban inequalities continue to divide the country. It urges policymakers to focus on state-specific and local challenges instead of relying on national averages that hide unequal realities.

Tone: Analytical, cautionary, and policy-driven.