Policy Shift Aims to Support Childless Couples as Population Ages

Chennai, Sept 15 — With registered births falling year after year and the elderly share of the population climbing, Tamil Nadu’s government has revamped its family‑welfare agenda to embed infertility care. The policy change makes the state the first in the nation to pair assisted‑reproduction services with a public welfare programme.

Historically, the scheme dealt with contraception, birth‑control measures and spacing between children. The new component will deliver intra‑uterine insemination (IUUI) and comprehensive pre‑conception counselling through district headquarters hospitals, covering districts that lack a government medical college.

According to official figures, births dropped from 939,000 in 2020 to 802,000 in 2025, driving the total fertility rate to 1.3 – well underneath the 2.1 replacement threshold. At the same time, residents aged 60 and older represent about 16 % of the total population, a share expected to edge toward 20 % by 2036.

The health department’s policy note cautioned that a protracted decline in fertility combined with an ageing populace could eventually curtail the labour force and trigger a net population decline. The government clarified that the measure will not coerce couples into child‑bearing nor incentivise larger families; existing contraceptive services and safe‑abortion provisions will continue.

An audit revealed that 25‑30 % of maternal deaths occur during later‑order pregnancies. Hence, the programme is deliberately aimed at couples experiencing difficulty conceiving rather than encouraging additional births among those who already have children. Rural health nurses will be instrumental in identifying infertile couples, providing counselling, and referring them to the nearest tertiary infertility centre.