According to the latest data from the United Nations Population Division, India’s fertility rate has seen a decline, from 5.9 in 1950 to 2.0 in 2023.

This figure is now below the replacement level of 2.1, reflecting a demographic shift with far-reaching implications.

The “replacement level” fertility rate means that each generation has enough children to replace itself. If the rate falls below 2.1, as it does in India, the population may begin to decline over time as fewer children are being born than people are dying.

While many factors are contributing to this decline in fertility rates, such as economic pressures, delayed marriage and gender inequality, doctors are seeing an increase in infertility cases that is exacerbating this decline.

“Many interconnected factors contribute to India’s declining fertility rates, including social changes and health concerns. Infertility is a growing problem, often resulting from a combination of lifestyle choices, environmental risks and medical conditions,” Dr Manjula NV, consultant, obstetrics and gynaecology, Ramaiah Memorial Hospital, told India Today Digital.

Role of health in fertility

Poor health can have a direct impact on fertility in both men and women. For example, conditions such as obesity, diabetes and polycystic ovary syndrome (PCOS) are on the rise in India and are known to reduce fertility in women.

Dr Manjula explained how increased stress, unhealthy diet, inadequate exercise and exposure to environmental toxins are contributing to reproductive health problems.

While women are struggling with the problems of thyroid, PCOS and obesity, men are seeing a decrease in sperm quality.

According to a study published in the Journal of Human Reproductive Sciences, PCOS affects about 20% of women of reproductive age in India, causing hormonal imbalance and irregular ovulation.

Similarly, according to the Indian Society of Assisted Reproduction, male infertility, which is often linked to lifestyle factors like smoking, alcohol consumption and obesity, accounts for about 50% of infertility cases in the country.

Additionally, untreated sexually transmitted infections and pelvic inflammatory diseases can also cause damage to the reproductive tract and infertility. “Unequal access to quality reproductive health services in India further complicates the situation,” said Dr Manjula.

Impact of nutrition and lifestyle

Nutrition plays an important role in reproductive health. Micronutrient deficiencies, such as low levels of folic acid, zinc and vitamin D, can interfere with fertility.

A Lancet study published in August this year showed that Indian women consume inadequate amounts of iodine compared to men, while more men than women consume inadequate amounts of zinc and magnesium.

“Each deficiency has its own health consequences, ranging from adverse pregnancy outcomes to blindness to increased susceptibility to infectious diseases,” Harvard researchers said in the Lancet study.

On the other hand, inactivity and stress common in urban populations are also linked to lower fertility rates.

environmental factors

Environmental factors, including pollution and endocrine-disrupting chemicals, are also causing fertility problems.

A study states that air pollution can affect sperm quality and ovarian reserve, increasing the burden of infertility.

Meanwhile, experts say economic stress and the rising costs of child care are influencing decisions to delay or limit family size, especially in urban areas.

India’s declining fertility rate signals progress in population control but highlights the need to address broader health challenges affecting reproductive health.