Fertility and contraceptive use in Tamil Nadu, Andhra Pradesh, and Uttar Pradesh.

Rates of total fertility (TFR) in Tamil Nadu and Andhra Pradesh are 2.5 and 2.6 children per woman, respectively. The practice of family planning in these states has therefore successfully reduced overall fertility. Uttar Pradesh, however, with a TFR of 4.8, by far the highest fertility of any state in India, still has a long way to go before achieving replacement fertility. This paper compares findings from these three states to determine if any lessons can be learned about how to reduce fertility in Uttar Pradesh and other high-fertility states. The percentage of women receiving antenatal care and the percentage of girls aged 6-14 years who attend school are the most powerful predictors of total fertility and contraceptive prevalence. The importance of antenatal care most likely reflects the double role of auxiliary nurse-midwives in delivering both health and family planning services. Success in Andhra Pradesh demonstrates the ability of a strong family welfare program to reduce fertility close to replacement levels without much economic or social development. A potentially effective strategy to reduce fertility in Uttar Pradesh and other high-fertility states should include strengthening the health and family welfare programs, which are known to be weak in such states. Improving literacy and education levels, especially of girls, is another important element.