The general fertility rate (GFR) has declined India As per the Sample Registration Survey Data (SRS) 2020, up 20% in the last decade. 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 sample registration survey data, the average GFR in India was 86.1 from 2008 to 2010 (three-year period) and has come down to 68.7 during 2018-20 (three-year average) in urban areas.
There are many reasons for this including factors such as education, family planning programs and lifestyle factors including stress. We find out the causes and how to manage fertility rates.
What are the reasons for the decline?
Dr Divya Kumar, Senior Consultant, Obstetrics and Gynecology, Accord Super Specialty Hospital, Faridabad, says, “Education (average school year for women), economy (Gross Domestic Product), religious beliefs, contraceptive prevalence rate (CPR) etc. There are many factors, the strength of family planning programmes, etc. affect the fertility rate of a country.”
In addition, late marriage and pregnancies planning at an early age (>35) are particularly harmful to the female partner. 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, especially in education and workplace opportunities thus giving women more freedom and freedom to make their own decisions. There is better provision of adolescent and reproductive health care which has kept women healthy,” Dr. Ash Sujit ji, Gynecologist, believes.
Also, access to and awareness of contraceptive and family planning advice empowers women to take control of their pregnancy. Dr Sujitji says, “The gap between marriage and the birth of the first child is also one of the major factors along with the increased age of marriage.”
In the past, poor child health care resulted in low population rates and increased fertility rates. This has changed significantly with the advent of better medical practices which have reduced child mortality and fertility rates.
The lifestyle changes affecting a woman’s fertility and a man’s sperm count are said to be largely unrelated, although this cannot be ignored. Complicated factors such as increased cost of living and social affluence with health expenditure are associated with decreased GFR.
Marriage and motherhood takes a back seat among educated and career-oriented women. “Tuberculosis is still prevalent among women from low socioeconomic strata and is one of the most common causes of infertility,” says Dr. Kumar.
Stressful lifestyle also aggravates the problem in both the sexes. Obesity is on the rise in India, with one in four people being overweight and increasing the risk of infertility.
Understanding low GFR issues:
This declining GFR will certainly affect the global economic and social fabric. It may be beneficial to the environment but its impact is still unclear and cannot be predicted. “Low GFR has led to an inverse age structure with longer life expectancy and an aging population that has put direct pressure on health care systems and the global workforce. Due to the diverse nature of this decline in rural areas compared to urban, Migration is increasing with fewer work opportunities,” says Dr. Sujit.
Redefining gender roles and finding new forms of employment with increasing work patterns at different ages, working on pension laws and migration/migration laws, and a focused health care policy will be the need of the hour. Dr Sujit ji feels that the changing geo-political framework should have better housing and educational provisions and more social security with social security programmes, thus creating a family friendly and child friendly society. And we must understand that no matter what changes in policies or plans, there should be no compromise in efforts to enhance women’s reproductive health or progress on women’s rights.
How can we treat it?
The management of infertility has been revolutionized in the last 40 years with the advent of IVF. Treatment depends on the cause, and it is individual. “We can have different methods from simple medication to timing of intercourse to IUI (intrauterine insemination) to advance procedures like IVF (in vitro-fertilization) and ICSI,” says Kumar.
In cancer patients who are undergoing chemo-radiotherapy, eggs and sperm can be frozen for future use.
Egg freezing is very helpful for women who want to postpone marriage and child birth due to professional commitments.
The age of the couple especially the female partner is the most important factor in achieving pregnancy through any treatment method, so couples unable to achieve pregnancy should seek help from an infertility specialist soon.
Healthy lifestyle like moderate physical exercise, balanced diet in youth helps in improving fertility rate.
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