Growing concerns over declining fertility rates

Are Indian couples choosing not to conceive or are medical reasons largely behind what is holding them back? We talk to experts to know more about the new demographic reality

- Sreya Deb

The fertility rate in India has been steadily declining over the past few decades, dropping below the replacement rate of 2.1 children per woman in many states to 1.9, as per the UNFPA's 2025 State of World Population (SOWP) Report. So are Indian women choosing not to give birth, or are medical complications largely behind what is holding them back?

Dr Hitesha Ramnani, consultant, in-vitro fertilisation (IVF), Kokilaben Dhirubhai Hospital, Mumbai, believes it is a combination of both. "It is a nuanced interplay between choice and circumstance," she says, adding, "Many urban women are indeed delaying childbirth by choice, prioritising career, financial stability, or personal readiness."

At a crossroads Enumerating the health conditions lending to the declining fertility rates in both men and women, Dr Ramnani says, "Polycystic Ovary Syndrome (PCOS), endometriosis, fibroids, thyroid disorders, and male infertility, lifestyle diseases like diabetes, obesity, hypertension are more common in younger age groups today, impacting fertility in both men and women." She adds that environmental pollution, long working hours, and poor sleep hygiene further add to the issue.

Medical infertility, especially age-related, becomes a bigger barrier after the age of 35, says Dr Ramnani. According to her, women today may be biologically less fertile when they are finally ready to conceive. By this age, issues like diminished ovarian reserve or poor egg quality begin to affect women as well.