Hyderabad: Andhra Pradesh’s experience shows how difficult it can be to reverse fertility decline once having fewer children becomes a social norm, an Economic Advisory Council to the Prime Minister (EAC-PM) working paper has said.Titled ‘The Ghost of Population Past: How Population Control Persists in India’, the paper argues that India’s family planning policies have continued to encourage smaller families even as several states have moved into a phase of low fertility. The authors caution that continuing such policies in these states could make it harder to reverse fertility decline later.
AP is cited as an example. It has had below replacement fertility level for more than two decades. The paper says the state now faces what it calls a behavioural tipping point. This is a stage at which having fewer children becomes so common that it begins to shape people’s expectations about what a normal family should look like.The paper cites research that puts this possible tipping point at around a total fertility rate (TFR) of 1.5. But it stresses that 1.5 is not a fixed cut off. What matters is that fertility stays very low for a long period, allowing smaller families to become deeply rooted as a social norm. Once this happens, encouraging people to have more children can become much harder, it says.AP’s own experience reflects this shift. Its family planning programme relied heavily on female sterilisation for decades. About seven in 10 married women in the state are sterilised, the highest share in the country, according to NFHS-6 data cited in paper. AP had also budgeted incentives for 1.25 lakh female sterilisation procedures every year.Sterilisation is a permanent method of preventing pregnancy. Spacing methods such as IUCDs and injectable contraception are temporary methods that allow couples to delay or space another pregnancy.The paper says AP’s system also gave health workers a financial reason to promote sterilisation. Asha workers and health providers received higher incentives for sterilisation than for spacing methods. In simple terms, a health worker could earn more for motivating a couple to choose permanent contraception than for helping them use a temporary method.AP’s own population policy acknowledges this, saying higher incentives for sterilisation had inadvertently encouraged health workers and providers to favour it over spacing methods. It proposes ending sterilisation incentives and instead incentivising spacing methods.AP has already begun changing course. Its 2026-27 programme has no allocation for incentives for male or female sterilisation. It has allocated ₹1 crore for reversible methods such as IUCDs and injectables.The state also repealed its two-child restriction in Nov 2024. The rule had restricted people with more than two children from contesting local body elections.Its proposed Population Management Programme 2026 now seeks to encourage second and third births. It proposes a one-time ₹2,000 incentive for a second child and ₹1,000 a month for five years for a third child. It also proposes govt coverage of education expenses and lifetime health insurance for households with three or more children.The financial difference is significant. AP had been allocating about ₹12 crore a year for direct payments linked to 1.25 lakh female sterilisations. The paper estimates that incentives for a similar number of second and third births could cost nearly ₹1,000 crore annually.But the paper cautions that money alone may not change family choices after a small family norm has become established. AP’s own population policy estimates that it could take five to 10 years for its share of sterilised married women to fall to 50%. The authors also caution that simply paying couples to have more children may not reverse long-term fertility decline. Similar incentives have not succeeded in reversing fertility declines in other countries, they pointed out.“The paper is not arguing against family planning, however. It says couples should have greater choice over when to have children and how many to have, with greater access to temporary methods that allow them to space pregnancies rather than incentives that encourage permanent sterilisation,” the authors said.