Although its fertility rate has declined from about 3.6 to 2.4 children in the last three decades, India is projected to become the world’s most populous nation by 2028, with a population of some 1.45 billion. Now a middle-income country, India has seen significant improvements in health and education but wide inequalities persist. Maternal mortality and gender discrimination remain high. Early marriage and pregnancy contribute to excessive maternal death among women under 24. The low status of women is a factor as well, one that is reflected in an extremely skewed ratio of girls to boys.