Gitanjali Banerjee
A surprising demographic shift is happening in India. Unbelievable but true that India, the most populous country of the world has its Total Fertility Rate (TFR) dropping. Infact in the recent years TFR has dropped to 2.0 (NFHS-5, 2019-21) which is marginally below the replacement indicator of 2.1. This paradox of a densely populated country facing falling fertility rate is indicative of underlying issues like infertility, socio-economic changes, cultural shift and gender issues. Thus, it is time to delve deeper into the healthcare framework and ensuring it is ready to handle the challenges of the tech savvy India.
Simply put, TFR is the average number of children a woman is expected to have during her reproductive years. On the bright side, a lower TFR signals socio-economic progress, which reflects in urbanization, career opportunities for women, better education and, higher healthcare standards. On the flip side, it also exposes a rise in infertility cases due to lifestyle changes, environmental factors, and delayed childbearing. Women have to bear the brunt of infertility more given the prevalent gender biases.
How Big Is the Problem of Infertility?
According to WHO, 1 in 10 couples, an approximate of 33 million Indians suffer from infertility (EY report 2017).
Lifestyle choices and environmental toxins adversely affect reproductive health especially hormones and mental health. Incidences of PCOS, obesity, endometriosis and male infertility are major contributors to this problem.
Rapid urbanization and career ambitions have led to delayed childbirth and late marriages. This often escalates the problem of infertility as age and fertility are inversely propotionate.
There is an interdependent relationship between stress and infertility which has a domino effect on the quality of life. A 2021 study published in the Journal of Psychosocial Research found that over 60% of Indian women undergoing infertility treatment experienced significant psychological distress
Social pressures emanating from gendered perspective of roles of men and women in society putting undue burden of childbearing on women despite socio-economic progress makes perceived image of infertility bigger than what it is in reality. 1/3rd of working women undergoing infertility treatment leave their jobs to focus on childbearing.
Couples deterred by high cost of fertility treatment and stigma often delay going for treatment escalating it into a chronic problem at a later stage. The average cost of an IVF cycle in India ranges from INR 1,00,000 to INR 3,00,000 (Indian Society for Assisted Reproduction, 2022), making it inaccessible for many couples. With multiple cycles often required, the financial burden is immense.
Government Interventions: Case Studies & Lessons
Telangana Government’s Free IVF Initiative
In 2024, the Telangana government launched state-sponsored free IVF treatment scheme to help couples struggling with infertility. The objective of this initiative is to provide financial and medical assistance for infertility treatment, making IVF accessible to low-income couples. Some government hospitals have been selected to implement this scheme and offer free IVF cycles, including diagnostic tests and medication support.
Delhi’s IVF Support Program
Delhi government also initiated subsidized IVF treatments in government hospitals. AIIMS, Lok Nayak Hospital and Safdarjung hospital provide IVF facility in Delhi currently.
Assisted Reproductive Technology (ART) Regulation Act, 2021:
Government initiated a dialogue with fertility stakeholders to draft a framework for ART treatments with special focus on surrogacy. It establishes ethical guidelines for IVF treatments, including licensing of clinics, consent requirements, and rights of donors and surrogates, but lacks comprehensive financial support mechanisms for patients.
Measuring the Impact: Implementation Success & Challenges
Infertility is a new age problem and ART treatments are less than 50 years old (first IVF done in 1978). Indian government is naturally aligned to population issues. With these ground realities, let’s assess the impact of government initiatives in a balanced way.
Successes
Government programs have helped reduce the financial burden, with Telangana’s initiative expected to benefit over 10,000 couples annually. Such government initiatives have increased financial accessibility to treatment. Studies indicate that free/subsidized IVF programs can reduce out-of-pocket expenses by up to 60% for eligible couples.
When government launches an initiative it sends a strong message to the society. The acceptance and awareness of infertility as a problem has increased. In recent years we have seen many celebrities opening up about their lived infertility experiences on social media platforms thus initiating an open conversation around infertility. This has also led to breaking of stigmas, better reporting and research on reproductive health trends.
Challenges
There is surely an awareness gap due to limited coverage about these government initiatives. Many eligible couples are unaware of the scheme due to inadequate outreach. Only a few government centers provide IVF, leaving out rural populations.
Infrastructure Deficit is quite evident as government hospitals lack the necessary expertise and equipment for high-quality ART (Assisted Reproductive Technology). Public hospitals are already overburdened and with limited resources and ART specialists it leads to long wait times and compromised quality of care.
While financial aid has increased, emotional and psychological support remains neglected in government initiatives. Infertility needs to managed from a ‘care’ perspective including mental health and holistic approach, which sadly is missing from the current initiatives. The approach of providing subsidized treatment is a linear solution with more of propaganda appeal than real impact.
Conclusion
Today, countries like Japan and Korea have such low fertility rate that their governments have launched aggressive mass initiatives and offers to motivate their people to bear children. The burden of ageing population is real. India needs to take pre-emptive steps to avoid such a future. Thus, the paradox of a declining Total Fertility Rate amid a large population necessitates urgent intervention in reproductive healthcare. A holistic fertility care framework, combined with medical support, mental health resources, lifestyle changes, education, and policy reforms, will ensure infertility treatments are accessible and effective. Strengthening ART regulations and improving financial aid will bridge existing gaps, ultimately improving India’s reproductive health landscape.
About the contributor: Gitanjali Banerjee is a fellow at Young Women Leaders in Public Policy Fellowship 2.0 and a founder at Fertility Dost.
Disclaimer: All views expressed in the article belong solely to the author and not necessarily to the organisation.
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Acknowledgment: This article was posted by Bhaktiba Jadeja, visiting researcher and assistant editor at IMPRI.
