India’s declining fertility rate: How does overall health impact reproduction?

India’s fertility rate has dropped from 5.9 in 1950 to 2.0 in 2023, according to the United Nations Population Division. This decline is below the replacement level of 2.1, a threshold that ensures each generation can replace itself. As fertility rates fall, the population may shrink over time.

Various factors contribute to this decline. Economic pressures, delayed marriages, and gender inequality are key drivers. However, doctors are also noting a rise in infertility cases, which is intensifying the trend. Dr. Manjula NV, an obstetrician, highlighted that lifestyle choices, environmental exposures, and medical conditions play a crucial role in declining fertility rates.

Poor health directly affects fertility in both men and women. Obesity, diabetes, and conditions like polycystic ovary syndrome (PCOS) are increasingly common in India and can reduce fertility in women. Dr. Manjula also pointed out that unhealthy diets, stress, and lack of exercise are contributing to reproductive health problems. Men are facing issues such as reduced sperm quality, often linked to smoking, alcohol, and obesity.

PCOS affects about 20% of Indian women of reproductive age, causing hormonal imbalances and irregular ovulation. Male infertility, which accounts for nearly 50% of infertility cases, is often linked to lifestyle factors. Untreated sexually transmitted infections and pelvic inflammatory diseases can also lead to infertility, with unequal access to quality healthcare further complicating the situation.

Nutrition plays a vital role in reproductive health. Deficiencies in micronutrients like folic acid, zinc, and vitamin D can affect fertility. A recent Lancet study revealed that Indian women consume insufficient iodine, while men are lacking zinc and magnesium. These deficiencies can lead to adverse health outcomes, including complications during pregnancy.

Environmental factors also contribute to declining fertility. Pollution and exposure to endocrine-disrupting chemicals harm sperm quality and ovarian reserves. Economic stress and the high cost of childcare, particularly in urban areas, are pushing people to delay or limit family size.

India’s declining fertility rate is a sign of progress in population control, but it underscores the need to address the broader health challenges affecting reproductive health.