NEW DELHI: Kerala, Tamil Nadu, Karnataka and Telangana have higher infertility rates than northern states, according to a recent study, which found that age at marriage, biological factors, and lifestyle factors are strongly linked to infertility.
The other states seeing similar infertility trends are Goa, Delhi, Sikkim, and Himachal Pradesh, said the study, which was published in PLOS One journal.
The study, “Surging trends of infertility and its behavioural determinants in India,” is based on the secondary data available after the four rounds of the National Family Health Surveys (NFHS) spread from 1992 to 2016.
The data showed many causes of infertility, like sexually transmitted diseases, lifestyle factors and healthcare practices, were curable.
It also pointed out that women suffer to a great extent from childlessness as compared with men, and they always bear the burden of psychological, family and community pressure.
It was observed that having multiple sex partners and sexually transmitted infections were significant causes of infertility and induced abortions.
“The infertility rate is higher in developing countries due to sexually transmitted infections and a lack of adequate and modern medical facilities,” said the study, conducted by the Centre of Social Medicine and Community Health (CSMCH), Jawaharlal Nehru University (JNU) and International Institute for Population Sciences (IIPS), Mumbai.
Many other factors contribute to the problem, which is declared a public health issue by the World Health Organisation (WHO).
Environmental, socio-economic and lifestyle-related issues increase infertility rates, the study said.
“These studies revealed that living environment of a couple such as frequent exposure to heat and noise etc have adverse effect on the couple’s reproductive life,” said the study, adding “people with high body mass index (BMI), that is, excess weight, have been shown to have a major impact on menstruation, infertility, miscarriage, pregnancy and labour.”
Cigarette smoking, alcohol consumption, induced abortions and prior contraceptive use also increase the risk of infertility.
“The estimates of the Census of India (1981, 1991, 2001) show that infertility in India has increased among reproductive-age couples. It has risen from 13 per cent in 1981 to 16 per cent in 2001 among ever-married women,” said the report, adding, “It was observed that the infertility rate has declined between 1998–99 and 2005–06. Furthermore, another study from India found that about eight per cent of currently married women suffered from primary and secondary infertility, of which 5.8% per cent were secondary infertile," it said.
WHO suggests that worldwide, about 8-12 per cent of couples suffer from infertility, and its incidence rate varies worldwide.
“In India, the infertility issue is serious yet neglected, and it is frequently overlooked in public health discussions, which may cause a huge adverse impact on people’s reproductive and productive life in the long-term,” Dr Balhasan Ali, one of the study's authors, told this paper.
He added that the country's rising infertility rate is a big issue, particularly in south Indian states. “This high infertility rate in southern states may also contribute to overall total fertility rate (TFR) decline.”
Ali, a demographer at the International Institute for Population Sciences, Mumbai, said although primary infertility – inability to conceive - has decreased modestly in recent decades, secondary infertility - inability to bear a child after having an earlier birth - has increased dramatically. This is mainly due to lifestyle choices.
The study suggested that primary fertility decreases with age and is higher among younger women, while secondary infertility is higher among older women.
Also, increasing education among girls leads to a low risk of infertility, especially secondary infertility. Similarly, rich and upper-caste women have a high risk of secondary infertility, while poor and lower-caste women have an increased risk of primary infertility.
Overall trends show that primary infertility declined, but secondary infertility increased massively in the last three decades.
“Working women have a high rate of infertility, which must be primarily due to a stressful work environment, which significantly impacts the menstrual cycle. Stressful life events like work stress and family pressure are associated with menstrual disorders, which lead to polycystic ovarian syndrome or disorder, and ultimately result in infertility,” the study said.
“We suggest enhancing the current health and reproductive programmes, educating people about improving their lifestyle choices and sexual behaviour and calling attention to a significant shift in fertility dynamics. The alarming trend of infertility necessitates the establishment of an infertility management chain comprised of trained doctors, counsellors, and health professionals who can provide information on cause and treatment at a reasonable cost,” Ali added.
“Offering incentives and subsidised treatment may be beneficial in reaching out to the marginalised sections who cannot afford expensive and long-term treatment. Infertility clinics can be opened in high-risk areas to identify the vulnerable population. Young males can be a susceptible group to infertility due to drastic changes in lifestyle behaviour; therefore, there is a need to educate men about infertility causes and treatment,” he added.
