The observed statistical correlation between increase in women's outside employment and decrease in birth rates has catapulated the demand for increasing women's wage employment as a primary goal, not necessarily on its own merits, but as part of the demographic drive to reduce fertility. At what costs to women's welfare do such demographic outcomes occur? The existing structural nature of women's work (domestic as well as non-domestic) has severe built-in hazards for women's health (reproductive and otherwise) which no amount of first rate quality of care and/or access to health services alone can deal with. Focusing on Tamil Nadu, the author argues in addition that a demographic model state need not necessarily be a reproductively safe place.