For Pranay and Nidhi, the cost of raising their three-year-old daughter was something they thought they had estimated correctly. Delivery, vaccinations and early doctor visits were expenses they had planned for. It was also almost the perfect time for them to start thinking about a second child. But visits to preschools near their house changed that calculation.
At Rs 60,000 for three months, the school they were considering for Paridhi would cost them Rs 2.4 lakh a year. And this was only the beginning of what could be a 12 to 15-year financial commitment. “I am not even opting for any branded or high-profile schools. These are schools around my home,” says Nidhi, who works in a bank.
She says the actual issue is not whether they want a second child. It is “whether we can afford to give two children the kind of education we want for them”. Her situation is hardly unusual.
The dimensions of this dilemma show up in the Outlook-Toluna Survey on motherhood in many ways.
Most importantly, it is evident in the gap between the kind of family the majority of women wish for and what they ultimately end up having. While India may still aspire to hum do, humare do, in line with the memorable national family-planning slogan of the past, many young couples are stopping at one.
The survey of 1,334 women found that 55 per cent of them consider two children their ideal family size, followed by 30 per cent who prefer one. In reality this order of preference gets flipped. Among mothers, the majority—which is 51 per cent—have stopped at one child, against 46 per cent who have two. The distance between those two numbers is a big reason why there is a gulf between India’s current fertility rate of 1.9 and the desired rate of 2.1 which is considered the replacement level for a population.
Why Does this Happen?
The survey results pointed to something important. It asked respondents who have been married but don’t yet have a child, what might prompt them to have a child in the future? And 53 per cent of them said it would be better finances or job security. In effect, the gap really lies between the family they would like and the family they ultimately feel they will be able to raise.
Heena Sidhu, an Olympian and former world No. 1 pistol shooter and Arjuna awardee, feels the real reason for the fertility rate drop is that raising children today is very expensive. “Highly educated couples know the importance of good-quality education, sport, art and music for their kids which makes their aspirations for their kids even more costly. Hence, they stop at maybe one or maximum two,” she said in a social-media post. “Creating good-quality schools and affordable pathways for couples to raise their children will be very important.”
The survey results echo her concerns. For most women, free quality health care (86 per cent) and free quality education (88 per cent) rank among the top three government policies that could make it easier to decide to have a child. An overwhelmingly larger share of women want these two rather than income-tax benefits (71 per cent) or cash transfers (55 per cent).
The Price of a ‘Good’ Education
When Priyanka and Saurabh, both of whom are factory workers, had to admit their five-year-old son to class one in Delhi, government school at a walking distance was the preferred choice. But a tour of the school forced them to change the decision. The ceiling was leaking in the monsoon; there was no drinking water; and multiple classes were held in one room. “We stopped at one child with the idea that we will give him a good life. Now, we are sending him to a private school, costing Rs 3,000 per month. That is a lot for us,” says Priyanka.
According to the Comprehensive Modular Survey on Education-2025, in urban India, only about three in 10 students are enrolled in government schools, while more than half attend recognised private unaided schools.
The average annual school-education expenditure per student in urban India was Rs 35,758 for recognised private unaided schools, compared with Rs 4,128 for government schools. This amount for private schools ranged from Rs 47,373 in Delhi to Rs 79,006 in Chandigarh and Rs 5,082 in Lakshadweep.
Urban cohorts are often having fewer children than they desire, suggesting that actual fertility and desired family size are not always the same thing.
So, for parents like Priyanka and Saurabh, with the total annual household income below Rs 5 lakh, selecting a good school for the child comes with a cost they can barely afford. The challenging part is that the financial commitment does not end with admission.
The National Sample Survey also shows average school-education expenditure rising through the school years: reaching Rs 29,286 per student at the higher-secondary level in urban India from Rs 18,943 at pre-primary levels.
But the cost of a “good” education begins even before the first fee is paid. At least in Delhi, getting a child into a sought-after private school has itself become a source of competition and anxiety. Thousands of parents apply for a limited number of seats.
In 2023, Ashneer Grover, an entrepreneur, reflecting on the experience of nursery admissions in Delhi-NCR, had described it as tougher than getting into the Indian Institutes of Technology, arguing that demand for coveted schools far outstrips supply. “If nursery school seats were auctioned in Delhi NCR, Indian Premier League would be the second-highest auction in the country,” he said.
For parents, it can mean months of uncertainty over which school their child will get into, how far they will have to travel and whether they can afford the fees once they secure a place. And even for families with a better financial cushion than Priyanka and Saurabh, the costs do not end with securing a school seat.
Education is not just a private investment for families. NITI Aayog’s 2026 report on school education calls investment in schooling “a foundational driver of long-term economic growth and national development”. It cites World Bank estimates that an additional year of average schooling is associated with a 0.37 per cent increase in gross domestic product growth.
For families, the cost of raising a child is not limited to planned expenses such as food, schooling or child care. An unexpected health crisis can alter the equation overnight.
When Health Care Changes the Equation
Alka, a teacher, thought she had ticked all the boxes. She was married, had a four-year-old son and had bought a house by 2022. The only thing she still hoped for was a second child, preferably a girl. When her daughter was born in 2023, she felt her family was finally complete. Everything seemed to be falling into place until a doctor told her that the baby had a ventricular septal defect (VSD): a hole between the heart’s lower chambers.
“We were not ready for that. Both our children were born through C-sections. The home and car equated monthly instalments were already going on. We never thought we would suddenly need Rs 10 lakh for an open-heart surgery,” she says. The surgery alone cost Rs 10 lakh, excluding repeated hospital visits, medical tests, medicines, hospitalisations and post-operative monitoring.
Alka had to quit her job because her daughter needed special care and constant monitoring. “Selling the car wouldn’t fetch us enough money, so we sold our house for her treatment. Whatever little we had saved over the years was spent on marriage, childbirth and down payments,” she says.
For her, the availability of a well-equipped government hospital could have changed the financial outcome. “There are only a few government hospitals in Faridabad,” she says. “And all of them have long waiting times. We even tried All India Institute of Medical Sciences, Delhi, the first date we got was after eight months and too only for consultation. We could not waste months in the condition my daughter had, so we continued in a private hospital that was suggested by multiple doctors.”
As for Priyanka who works in a small factory in Delhi, she has given up on the nearby government dispensary. “Every time my son is sick, we have to take him to a private hospital or dispensary because there is no government hospital nearby and the dispensary does not have a doctor most of the time,” she says. “Taking him to a faraway government hospital means losing a day’s pay for us.”
Private hospitalisation costs nearly eight times as much as government hospitalisation. Government records show that the average cost of hospitalisation is Rs 50,508 in private hospitals, compared with Rs 6,631 in government hospitals. As per the 80th National Statistical Office Survey-2025, for childbirth, average out-of-pocket medical expenditure was Rs 37,630 in private hospitals, against Rs 2,299 in public facilities.
A parliamentary standing committee on health and family welfare in its August 2026 report also highlighted the difference in outpatient costs: the average expenditure was Rs 289 in government hospitals, compared with Rs 1,447 in private hospitals. “Treatment in private hospitals is often five to ten times costlier than in government facilities, with childbirth and serious illnesses like cancer, heart disease and kidney failure reflecting the sharpest divides. The average cost of inpatient treatment for an illness in India is about Rs 37,858 while out-of-pocket expenditure is about Rs 34,064,” the committee said, adding that the gap widens further for serious illnesses.
A 2021 NITI Aayog report noted that low government spending on health had constrained the capacity and quality of services in the public sector, with overburdened public hospitals often diverting patients to the costlier private sector. Nearly 60 per cent of hospitalisations and 70 per cent of outpatient services were delivered by private providers, it noted, citing the National Sample Survey Office’s 2017–18 health survey.
From Population Control to Pronatalism
For decades, India’s population policy was oriented towards smaller families, with several states introducing two-child norms for local-body elections and, in some cases, government employment. When India became independent, its fertility rate was at 5.9.
From that point, it took the country several decades of population control to reach a replacement-level fertility rate of 2.1. A replacement level of 2.1 is the average number of children born per woman needed to keep a population size stable from one generation to the next. For instance, Keralam (1988) and Tamil Nadu (1993) were among the first states to achieve replacement-level fertility in India. Andhra Pradesh joined the group in 2001, followed by Karnataka in 2004. Rajasthan joined the group in 2019 and Madhya Pradesh in 2023.
As several states crossed the 2.1 threshold and fertility continued to fall below replacement level, the narrative began to shift. As of now only Bihar, Uttar Pradesh and Jharkhand have a total fertility rate above 2.1 among the larger states. India has touched replacement fertility since 2019, according to the National Family Health Survey.
The emphasis gradually shifted from population control to population stabilisation—and, increasingly, to pronatalism: from persuading women to have fewer children to worrying about why they were having fewer.
India’s fertility debate may be less about the size of a cheque at the time of childbirth and more about the cost of raising a child after it.
Meanwhile, the policies are also beginning to change.
Andhra Pradesh repealed its two-child restrictions in November 2024 and Telangana did the same in January 2026. Rajasthan repealed its two-child norm provisions of the Panchayati Raj Act in March 2026 and Madhya Pradesh withdrew its two-child norm restrictions for government service in June 2026. In 2026, the Tamil Nadu government announced fully paid maternity leave for a year for female government employees for the birth of their third child. There were a series of other incentives, too, to encourage more births. Rajasthan provides Rs 6,000 in three instalments for the birth of a second child under its Mukhya Mantri Matratva Poshan Yojana. At the national level, eligible women receive Rs 6,000 for a second child if the child is a girl under the Pradhan Mantri Matru Vandana Yojana.
Yet, the larger question is whether these incentives are enough to cover the cost of raising a child.
Even governments seeking to encourage larger families are beginning to recognise that the costs extend well beyond childbirth. Under the newly proposed Andhra Pradesh Population Management Programme 2026, the state has announced cash incentives for families having a third (Rs 30,000) and fourth (Rs 40,000) child. The new policy proposes a one-time direct cash incentive of Rs 2,000 for a second child and onwards, and a monthly stipend of Rs 1,000 for the third child’s first five years. It also proposes full government coverage of educational expenses, and lifetime health insurance to any household with three or more children. Sikkim has introduced measures ranging from salary increments for government employees having additional children to fertility-treatment assistance and child-care support. But these are just two states acknowledging the reality.
The Deloitte Global 2026 Gen Z and Millennial Survey found that 54 per cent of Gen Zs and 44 per cent of millennials in India say they have delayed major life decisions due to their financial situation. Four to five of 10 Gen Zs and millennials are living paycheque to paycheque. At least 20 per cent Gen Zs and 13 per cent millennials struggle to pay monthly living expenses.
When Alka, Priyanka and Nidhi were asked if a one-time incentive would encourage them to have one more child, all three said the child needs much more than just nutrition and one-time financial help. Alka pointed out that if the government infrastructure had been good and her daughter could get treatment there at a lower cost, she wouldn’t have had to sell her house.
“We should think about what is there to offer those who are living before bringing more children to this world,” she says.
For Priyanka, affordable, if not free, education and health care are important for the survival of even her family of three. “We have to send our child to school, take care of the health-care needs for all of us and also save for the future. Adding one more member to the family will mean we can never step out of this situation,” she says.
Even though Nidhi comes from a better financial background, the school fees of a second child would mean cutting down on a lot of things. “If we send the child to a decent school, we expect her to pick a decent career too. We also need to plan for higher education while continuing to maintain a lifestyle we can enjoy,” she says. Echoing the sentiments of the women included in the Outlook-Toluna Survey, Nidhi says that she cannot plan for another child if the fee is going to be this high.
With almost nine in 10 women citing free quality health care and free quality education among policies that could make it easier to decide to have another child, it is quite clear that the policy response to India’s fertility situation can’t be a cheque at the time of childbirth. It has to be about the cost of raising a child for many years afterwards.
(Some names have been changed to protect privacy)
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Nivedita Singh is senior correspondent, Outlook
Fozia Yasin is senior associate editor, Outlook
