No, freemarket decides, can't afford, no meds, unless you are servery disabled, down-syndrome and the like. No sterilizations, they could be permanent, cause modification and everybody doesn't deserve them, some could likely do well for society by having more children, let the creative and responsible has as many children as they can. As to the rest, well they better start studing and playing fairly, the people who have spent their lives in hope of this development are not slaves.
A SKILLED older population bring a HUGE benifit to the society and the economy. remember that it costs R3 million to raise an American child, about the same in France, and that it is only in these nations where these type of solutions are found 300/mn patents, compared to SA at less than 0.5 international patents per million. An increased populaiton of the skilled would arm us with far greater tools to take care of ourselves and the planet, while a higher population of the unskilled and less creative will only create more need for basic resources and land. illionare and poor man use same amount of fuel and land, now the rich man could afford an electric car too and he will be paying for it's further development.
Either you could afford a child and are able to take care of the child (mandatory-abortion policy), or you don't hav one, such a policy would bring far enough money to the economy to make even the poorest worker afford decent medical care, as to the rest, well we don't have people stuck in horrid situations that they aren't able to pull themselves out of for all eternity. and we will always have an ample supply of the lazy too so leave them to some work.