Replacement-Level Fertility and Population Ageing in India: Implications for Nursing Practice and Public Health – A Review of Current Trends

Abstract

India is undergoing a significant demographic transition characterized by declining fertility rates and increasing life expectancy. The achievement of replacement-level fertility represents a major milestone in population stabilization; however, it simultaneously contributes to rapid population ageing. The present review aims to examine current trends in replacement-level fertility and population ageing in India and to explore their implications for nursing practice and public health. Literature was reviewed from peer-reviewed journals, government reports, census publications, National Family Health Survey reports, Sample Registration System reports, and publications from international organizations. Evidence indicates that India's Total Fertility Rate has declined from over 5 children per woman during the 1970s to nearly replacement level in recent years. Simultaneously, improvements in healthcare, nutrition, sanitation, and socioeconomic conditions have increased life expectancy and expanded the elderly population. The ageing population is associated with a rising prevalence of chronic diseases, disability, dependency, mental health issues, and increased demand for long-term care services. These demographic changes pose substantial challenges for healthcare systems, particularly nursing services. Strengthening geriatric nursing education, community-based healthcare programs, preventive health services, and healthy ageing policies is essential. Effective public health planning and workforce development are critical for addressing the healthcare needs of India's ageing population while maintaining the benefits achieved through fertility transition.