Published May 19, 2026 | 7:03 AM ⚊ Updated May 19, 2026 | 7:03 AM
Second and third-born children are five percentage points less likely to be delivered in an institutional facility.
Synopsis: According to the National Sample Survey Office (NSSO)’s household consumption expenditure survey, a woman who delivers at an urban private hospital in Andhra Pradesh spends an average of ₹63,989 across antenatal care, delivery, and post-natal care. The incentive covers less than half that figure.
Andhra Pradesh Chief Minister N Chandrababu Naidu announced ₹30,000 for a third child and ₹40,000 for a fourth, payable at birth. The government positioned the incentive as support for families willing to grow.
The government’s own data positions it differently. According to the National Sample Survey Office (NSSO)’s household consumption expenditure survey, a woman who delivers at an urban private hospital in Andhra Pradesh spends an average of ₹63,989 across antenatal care, delivery, and post-natal care. The incentive covers less than half that figure.
Even at a rural government hospital — the cheapest option available — the total expenditure per pregnancy runs to ₹17,993. The incentive for a third child exceeds that number. But a rural government hospital is not where most Andhra Pradesh families deliver.
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Andhra Pradesh recorded a Total Fertility Rate of 1.5 in 2023, against the national average of 1.9 and the replacement level of 2.1. The state’s Crude Birth Rate runs at 15 per 1,000 people, among the lowest in India.
The birth order data makes the government’s concern legible. In 2023, Andhra Pradesh recorded the lowest share of fourth-order births among all larger states — just 0.4%, against a national figure of 3.6%. Third-order births stood at 3.8%, also among the lowest. Telangana recorded the highest share of first-order births at 82.4%. Andhra Pradesh sat at 71.9%.
Families in Andhra Pradesh have already decided. They stop at one or two children. The TFR has fallen from 1.8 in 2011-13 to 1.5 in 2021-23, a decline of 16.7%. In urban Andhra Pradesh, it stands at 1.3. The state is not approaching below-replacement fertility. It is already there.
The incentive is the government’s attempt to change that arithmetic with cash.
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The NSSO data breaks the cost of pregnancy into three components: antenatal care, the delivery itself, and postnatal care.
In rural Andhra Pradesh, antenatal care costs an average of ₹11,059. Post-natal care adds ₹2,576. Together, maternal care alone runs to ₹13,635 before the delivery begins.
In urban areas, those figures rise. Antenatal care costs ₹13,182. Post-natal care adds ₹2,983. Total maternal care in urban Andhra Pradesh runs ₹16,165.
The delivery cost sits on top of that entire structure.
At a rural government hospital, the medical bill for delivery runs ₹1,774. At an urban government hospital, it runs ₹3,634. These are the numbers that make the incentive look sufficient. They are also the numbers that describe a minority of deliveries.
At a rural private hospital, the medical cost of delivery is ₹35,665. A normal delivery costs ₹25,114. A caesarean costs ₹40,700. At an urban private hospital, the average medical cost reaches ₹44,841. A normal delivery makes the family poorer by ₹24,797. A caesarean costs ₹52,449.
The out-of-pocket cost, what the household actually pays after any reimbursement, runs ₹36,512 at a rural private hospital and ₹40,609 at an urban private hospital.
A woman in urban Andhra Pradesh, who delivers by caesarean at a private hospital, and receives full antenatal and post-natal care, crosses ₹70,000 in total household expenditure.
The government offers ₹40,000 for a fourth child!
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The gap between public and private delivery costs deserves its own accounting.
At a rural government hospital, a normal delivery costs ₹1,774. A caesarean costs ₹3,022. At a rural private hospital, a normal delivery costs ₹25,114. A caesarean costs ₹40,700.
The gap between a government caesarean and a private caesarean in rural areas runs more than 13 times.
Andhra Pradesh records 33.3% of deliveries at private hospitals in rural areas and 47.5% in urban areas. Private delivery is the norm for a substantial share of families, the incentive targets.
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The cost arithmetic shifts further against families with each subsequent child, and not only because the bills accumulate.
A 2024 paper from Ashoka University, published as Economics Discussion Paper 118, examined maternal health-seeking behaviour across birth orders in India using data from two waves of the National Family Health Survey. Researchers Abhishek Dureja of Plaksha University and Digvijay S Negi of Ashoka University tracked over 1,11,000 births from more than 52,000 mothers.
They found that second and third-born children are five percentage points less likely to be delivered in an institutional facility compared to the first-born. Medically supervised births decline by four percentage points with each higher birth order.
The paper identifies two drivers. The first is financial constraint; resources are diluted as family size grows. The second is behavioural: a complication-free first delivery reduces a mother’s perceived risk, making her less likely to seek institutional care for subsequent births.
The consequence is measurable. Children delivered outside institutional facilities are less likely to receive BCG and polio vaccines administered at birth. The birth order gradient in institutional delivery produces a birth order gradient in immunisation.
The incentive pushes families toward higher birth orders. The research shows that those higher birth orders already carry lower institutional delivery rates. The policy and the evidence move in opposite directions.
Dr Sivranajani Santosh, a paediatrician, addressed the incentive without addressing its politics.
“Please, don’t put a political angle to what I am saying. I am saying this as a pediatric doctor, as someone who thinks about children,” she said.
She discussed questions a family should answer before a third child arrives: Food, healthcare, space, education, and the capacity and patience to raise another person.
“This ₹30,000 will get exhausted in a few days,” she said. “After that, will I be able to raise them properly?”
The NSSO data answers that question numerically. At a rural private hospital, the medical bill for delivery alone runs ₹38,363. The doctor’s fees account for ₹16,069. Medicines add ₹4,702. Diagnostics cost ₹2,487. Bed charges add ₹4,184. A package component absorbs another ₹9,906. Non-medical costs, transport, and food, add ₹3,823. Total expenditure at a rural private hospital runs ₹42,185.
The ₹30,000 incentive does not cover delivery at a rural private hospital. It does not cover antenatal care. It does not cover post-natal care. It arrives once, at birth, and it runs out.
“Before deciding to have a third child for ₹30,000 or a fourth child for ₹40,000, think about this: Will I be able to provide proper food for that child? Will I be able to provide good healthcare?” Dr Santosh asked.
“Please, do not have children just because of the temptation of ₹30,000 or ₹40,000.”
