Like many other topics, infertility also contributes to a growing public concern in India, affecting a precise proportion of women of reproductive age. According to the National Family Health Survey-5 (NFHS-5, 2019–21), the prevalence rate identified among currently married women aged between 15-49 years who have been married for at least five years is approximately 18.7 per 1,000 women (1.87%) nationally.
As we have noticed, India’s total fertility (TFR) has declined over recent decades-meaning the average number of children a woman is expected to have in their reproductive years. According to the National Family Health Survey (NFHS-5, 2019-21), the national TFR stands at 2.0, close to the replacement level of 2.1. The decline has led to an increase in improved awareness regarding family planning and reproductive health services. However, this also points out advanced and emerging challenges related to fertility in several regions.
In India, the fertility rate differs from one another largely with some states exhibiting rates well below replacement and others maintaining higher fertility levels. Such identified differences shape in change in the pattern of infertility and reproductive health needs across different states in the country.
Southern states including some northern states, have presented their records of fertility, which is significantly below their replacement levels. This indicates the challenges women are prone to related to their infertility and delayed childbearing.
As we noticed, these states are considered to be low fertility states, denoting that couples are more prone to infertility due to delaying childbearing for their personal or professional reasons. The issues related to age and infertility, Assisted reproductive technologies (ART) like IV,F are increasingly sought after in these regions.
In contrast, states such as Bihar (TFR 3.0), Uttar Pradesh (2.4), Jharkhand (2.3), Madhya Pradesh (2.0), and Rajasthan (2.0) maintain fertility rates above or near replacement levels. These states reflect that they have higher fertility, which does not indicate the absence of infertility, but have different reproductive dynamics, such as early marriage and childbearing.
Moreover, these states have limited access ot healthcare, cultural preferences, and have lower literacy rates while demanding large families. In these states, infertility might not be reported or addressed due to social stigma and limited access to healthcare.
Fertility rates also differ markedly between urban and rural areas within states. For example, Bihar’s rural fertility rate is 3.1 compared to 2.4 in urban areas, while West Bengal shows 1.7 in rural and 1.4 in urban settings.
Urban areas typically have lower fertility rates due to better education, employment opportunities, and access to contraception. However, urban couples may face higher infertility rates linked to lifestyle factors such as stress, delayed marriage, and environmental exposures.
According to NFHS-5 data, the national prevalence of primary infertility—defined as the inability to conceive after five or more years of marriage—is 18.7 per 1,000 women currently in union. This rate varies with the duration of marriage: (Infertility Burden Across Indian States: Insights from a Nationally Representative Survey Conducted During 2019–21 – PMC, Infertility Burden Across Indian States: Insights from a Nationally Representative Survey Conducted During 2019-21)
These figures highlight a decreasing trend in infertility prevalence as the duration of marriage increases, suggesting that early intervention may be crucial. (Infertility Burden Across Indian States: Insights from a Nationally Representative Survey Conducted During 2019–21 – PMC)
The prevalence of infertility varies significantly across different states and union territories in India. Notably, regions such as Goa, Lakshadweep, and Chhattisgarh exhibit the highest burdens, while states like Ladakh, Uttarakhand, and Meghalaya report the lowest prevalence rates. (Infertility Burden Across Indian States: Insights from a Nationally Representative Survey Conducted During 2019–21 – PMC).
These disparities may be attributed to various factors, including socioeconomic conditions, healthcare access, and cultural practices.
Several factors influence the prevalence of infertility in India:
These factors underscore the complex interplay between individual choices, socioeconomic status, and reproductive health.
The rising prevalence of infertility necessitates urgent attention from policymakers and healthcare providers. Currently, infertility is not adequately addressed in India’s national health programs, reflecting a gap in the healthcare system. Establishing a national infertility surveillance system is crucial for informed decision-making and resource allocation. (Infertility Burden Across Indian States: Insights from a Nationally Representative Survey Conducted During 2019–21 – PMC)
Furthermore, integrating infertility management into primary healthcare services can ensure early diagnosis and treatment, reducing the social stigma associated with the condition. (Infertility Burden Across Indian States: Insights from a Nationally Representative Survey Conducted During 2019–21 – PMC)
Infertility is a growing concern in India, with significant regional variations and socioeconomic determinants influencing its prevalence. Addressing this issue requires a multifaceted approach, including policy reforms, public awareness campaigns, and enhanced healthcare services. By prioritizing infertility as a public health issue, India can improve the quality of life for affected individuals and couples, fostering a more inclusive healthcare environment.