The Empowered Action Group (EAG) States: India’s Health and Population Priority List

The eight

• Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Odisha, Rajasthan, Uttar Pradesh and Uttarakhand.
• They lag behind national averages on key health and population indicators.
• They generally show higher infant and maternal mortality.
• They also tend to have higher fertility than most other states.

Why the label matters

• The National Rural Health Mission (NRHM) gave these states special focus. See NHM on NRHM.
• NRHM’s wider “high-focus” list had 18 states: the EAG eight, the eight North-Eastern states, Himachal Pradesh and Jammu and Kashmir.
• Schemes often set separate, tougher targets for EAG states.

Tools used in these states

• NRHM began in 2005. In 2013 it merged with an urban mission to form the National Health Mission.
• ASHA workers are village women who link families to health services.
• Janani Suraksha Yojana pays cash to mothers for giving birth in a health facility.
• Janani Shishu Suraksha Karyakram (2011) made delivery and newborn care free in public hospitals.
• Mission Parivar Vikas (2016) targets 146 high-fertility districts in seven states: UP, Bihar, Rajasthan, MP, Chhattisgarh, Jharkhand and Assam.
• Assam appears in that mission, but it is still not one of the eight EAG states.

Size matters

• In Census 2011 these eight states held about 46% of India’s population.
• Uttar Pradesh alone had nearly 200 million people.
• So their higher fertility and mortality drag the national average.

Two Indias, demographically

• Southern and western states reached replacement-level fertility much earlier.
• Averages can hide this gap. A good national number can sit on top of poor outcomes in the EAG states.
• This is why policymakers aim extra funds and attention at them.

Why numbers stay high even as fertility falls

• These states have a large share of young people.
• Even if each woman has fewer children, more women are entering their childbearing years.
• Demographers call this population momentum.
• So total births stay high for years after the TFR drops.
• Poverty, low female schooling and weaker health systems add to the gap.

A moving target

• Odisha and Uttarakhand now sit below replacement fertility.
• Several EAG states still lag.
• Progress in these states is treated as a test of India’s overall health policy.

Linked reading

• National targets they struggled to meet: India’s population policy.
• The data behind them: Census 2011.
• The opposite problem in the south: depopulation.

SRS 2024

• India’s TFR was 1.9 in 2024, below the 2.1 replacement level.
• Six states remain above replacement, in order: Bihar, Uttar Pradesh, Madhya Pradesh, Rajasthan, Chhattisgarh and Jharkhand.
• All six are EAG states.
• Bihar has the highest TFR, at 2.9. Over a decade it fell by only 9.4%.
• Source: The Wire on SRS 2024.