When Kerala became the first State in India to achieve below-replacement fertility in the 1990s, it was celebrated as a triumph of development, and proof that education, healthcare and women’s empowerment could transform society.
Three decades later, that success is reshaping Kerala in a far more complex way.
Bearly one in five (or 20 per cent) Keralites ais eabove 60 years, compared with taround 12 per cent nationally, according to the UN Fund For Population Activities’ Indian Ageing Report 2023 and the Kerala Ageing Survey conducted by the Centre for Development Studies, among other sources. Prther, sby 2036, seniors could make up b23- 0 per cent of the population in Kerala, making it Knot only India’s most aged State, but also one of its fastest ageing ones
An older population translates into ta rising demand for hospitals, long-term care facilities, home nursing services and geriatric specialists. It also means fewer working-age people to support economic growth and the expanding needs of the elderly. Traditional family structures, once the bedrock bof elder care, are changing as younger generations migrate for work,and nuclear families become the norm.
Price of progress
“Kerala’s demographic change is fundamentally driven by socio-economic progress,” says Rajeev Jayadevan, Convener of the Research Cell of tKerala State Indian Medical Association. “Women’s empowerment, universal female education and higher employment among women have altered how families plan their lives. Marriage happens at a later age. Childbirth is delayed. Families are smaller and more deliberate in their choices.”
Contraceptive use in Kerala has increased from 53 per cent to 61 per cent in five years, according to athe National Family Health Survey. Unplanned pregnancies are rare. These shifts enabled Kerala to achieve below-replacement fertility earlier than any other IState.
“But every demographic dividend has a flip side,” Jayadevan says. “When fewer children are born over a long period and people live longer, the share of older people inevitably rises.” This Tis bvisible across Kerala — in outpatient queues dominated by grey heads, in rising cases of chronic illness, dementia and mobility issues, and in the growing number of elderly widows, often with limited financial security.
Financial strain
For the State, the challenge is no longer just about longevity, but also aquality of life in old age, he adds.
The associated financial needs crequire careful planning to avert pcatastrophic expenses during a period,when earnings have stopped and savings may mhave been used up. Existing health insurances may mnot cover long-term home-care costs, rehabilitation and palliative services, he says
Prevailing cultural norms place rthe burden of caring for the elderly fdisproportionately on younger women in the household, who may have to give up their oproductive employment to meet this need
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Published on January 26, 2026