The General Fertility Rate (GFR) has declined in India by 20% over the past decade, as per the Sample Registration Survey Data (SRS) 2020. GFR refers to the number of children born per 1,000 women in a year in the reproductive age group of 15-49 years. According to the Sample Registration Survey data, the average GFR in India stood at 86.1 from 2008 to 2010 (three-year period) and has come down to 68.7 during 2018-20 (average of three years) in urban areas.
The reasons are many including factors like education, family planning programs and lifestyle factors including stress. We figure out the reasons and how to manage the fertility rate.
What are the reasons for the decline?
Dr. Divya Kumar, Senior Consultant, Obstetrics & Gynaecology, Accord Super Speciality Hospital, Faridabad, says, “Many factors like education (mean school years for females), economy (Gross Domestic Product), religious beliefs, contraceptive prevalence rate (CPR), the strength of family planning programs, etc influence the fertility rates of a country.”
Also, late marriages and planning a pregnancy at advance age (>35) especially that of female partner which is more detrimental. Ovarian aging in Indian women is 6 years faster than their counterparts in other parts of the world like Spain.
“There has been a positive change, particularly in education and workplace opportunities thus giving women more independence and freedom to make their own decisions. There is the better provision of adolescent and reproductive health care which has kept women healthy,” believes Dr. Ash Sujit G, Gynaeocologist.
Also, access to and awareness of contraception and family planning advice gives women the right to control their pregnancy. “The increased age of marriage coupled with an increased interval between marriage and first childbirth is also one of the key factors,” adds Dr Sujit G.
In the past, poor child healthcare led to a low population rate and increased fertility rate. This has changed significantly with the advent of better medical practices thus lowering child mortality and reducing fertility rates.
Lifestyle changes affecting a woman’s fertility and a male’s sperm count are said to not be substantially related though this cannot be neglected. Confounding factors like societal prosperity along with the increased cost of living and health expenditure are associated with decreased GFR.
In educated and career-oriented women marriage and motherhood takes a back seat. “In women from low socioeconomic strata tuberculosis is still prevalent and is one of the commonest causes of infertility,” adds Dr Kumar.
Stressful lifestyle also adds to the problem in both sexes. Obesity is on the rise in India, with one out of every four people being overweight and it also increases the risk of infertility.
Understanding issues with a low GFR:
This decreasing GFR will definitely affect the global economic and social fabric. It may be beneficial to the environment but its effect is still unclear and cannot be predicted. “Lower GFR has led to an inverted age structure with increased life expectancy and more aging population which has directly put pressure on healthcare systems and the global workforce. Due to the diverse nature of this decline in rural vis-à-vis urban, there has been an increasing migration with lesser work opportunities,” says Dr Sujit G.
Redefining gender roles and finding newer forms of employment with increasing work patterns to different ages, working out the pension laws and migration/emigration laws, and a focused health care policy will form the need of the hour. Dr Sujit G feels there must be more social security with better housing and educational provisions, and social security programs in the shifting geopolitical structure, thus creating a family-friendly and child-friendly society. And we must understand that whatever may be the change in policies or plans there should not be any compromise on efforts to enhance women’s reproductive health or progress on women’s rights.
How can we treat this?
In past 40 yrs with the advent of IVF the management of infertility has been revolutionized. The treatment depends on the cause, and it is individualized. “The different modalities we have can range from simple medication to timing of intercourse to IUI (intrauterine insemination) to advance procedures like IVF(in vitro-fertilization) and ICSI,” opines Dr Kumar.
In cancer patients who are undergoing chemo- radiotherapy eggs and spermatozoa can be frozen for future use.
Egg freezing is of great help on women who wants to postpone marriage and childbearing due to professional commitments.
Age of couple especially female partner is most important factor in achieving pregnancy through any treatment modality, hence couple unable to achieve pregnancy should seek help from an infertility specialist soon.
Healthy lifestyle like moderate physical exercise, balanced diet in youth help in improving fertility rates.
