India’s fertility rate dips. This is how diabetes, obesity, and anaemia impact it

Over the past two decades, India’s fertility rates have been showing a downward trend. According to the latest findings of the National Family Health Survey 2019-21 (NFHS-5) survey, the average number of children born to a woman during her lifetime has dipped below the replacement level for the first time. In the NFHS 2015-16 survey, the national total fertility rate (TFR) was determined to be 2.2, down from 2.7 in the NFHS 2005-06 survey. According to the most recent NFHS survey, this has dropped to 2.1 in rural regions and 1.6 in urban areas.

While this is being termed by several experts as a major demographic milestone of replacement-level fertility, the same survey also reveals several falling nutritional indicators. When comparing NFHS-5 national-level data to NFHS-4 national-level data, there is a significant increase in the number of individuals suffering from obesity, high blood sugar levels, hypertension and increase in the number of people suffering from conditions like anaemia.

What did it reveal?

Nearly a quarter of the men and women polled were overweight or obese, with a body mass index of more than 25 kg/square metre. In comparison, the NFHS-4 had shown that 19 percent of men and 21 percent of women were overweight or obese. The study found that 15.6 percent of men and 13.5 percent of the women were found to have high or very high blood sugar levels. Overweight or obese men and women made up one-third of the urban population. Approximately 18 percent of men and 16 percent of women had high blood sugar levels or were taking medication to treat it.

Certain health indices, such as anaemia and obesity, were mostly observed among women. The percentage of anaemic women rose to 57 percent from 53.1 percent and anaemic adolescent girls to 59.1 percent from 54.1 percent.

With the Covid-19 pandemic taking a toll on people’s daily routines, it brought about several lifestyle changes in people. As fear of the disease grew people started resorting to a sedentary lifestyle and comfort foods like sweets came to a quick rescue. Consequently, these behaviours started taking a further toll on the already progressively worsening health conditions of the mass, which existed even before Covid-19 hit the world.

For most men and women, becoming a parent is one of the most fundamental transformations, and the stress associated with not being able to have a child can lead to emotional and mental health deterioration. 

Also, read: Infertility mythbuster: Birth control does not affect fertility

Let’s take a look at how the alarming rise in diabetes, obesity and anaemia can be a warning sign for couples planning to have a family.

Impact of diabetes on fertility

Diabetes has an effect on fertility of men in the form of altered hormone levels, lower sperm quality, and trouble in obtaining an erection and ejaculation. Men with type 1 diabetes have sperm that are less motile than their peers, and this is seen to worsen over time. When testosterone is at a lower than normal level in men, it is connected to higher fat deposition, resulting in obesity. This, in turn, can cause type 2 diabetes by increasing insulin resistance. Furthermore, decreased testosterone levels contribute to a reduction in sperm count and libido.

If a person has had diabetes for a long period, complications in the nerves and issues with blood circulation might occur. This might manifest itself as erectile dysfunction, or difficulty obtaining an erection, as well as ejaculation issues, thus negatively affecting their fertility.

In women, compared to their non-diabetic peers, type 1 diabetes patients have delayed menarche and early start of menopause, as well as delayed ovulation and irregular menstrual cycles. Furthermore, this reduces chance of getting pregnant and raises chance of miscarriage and stillbirth.

In type 2 diabetes, insulin resistance is observed where there is extra insulin that isn’t being used, in addition to an excess of blood sugar. Polycystic ovarian syndrome (PCOS) affects 5-13 percent of women of reproductive age and is linked to insulin resistance and increased testosterone levels. 

In most situations, it contributes to female infertility. Both type 1 and type 2 diabetes are associated with irregular menstruation, which can make it difficult for women to conceive.

Impact of obesity on fertility

Obesity has long been recognised to have detrimental reproductive consequences and its impact can be multi-faceted. Menstrual disorders and anovulation (when an egg doesn’t release from your ovary during your menstrual cycle) are more common in overweight women. Women who are overweight or obese are at a higher risk of having a miscarriage. These women have a higher risk of infertility, as well as higher risks of conception, miscarriage, and pregnancy problems. Obesity causes infertility in a variety of ways in women, including poor ovarian follicular growth, oocyte development, fertilisation, embryo development, and implantation.

In men, the present downward trend in sperm parameters corresponds to the global rise in obesity rates. Fertility in obese males may be compromised by sexual dysfunction, endocrinopathy (disease of the endocrine gland), and other factors, in addition to poor semen quality.

Also, read: Are obese women more prone to infertility? An expert tells you about it

Impact of anaemia on fertility

There is a close relationship between deficiency in trace elements and unexplained infertility in females. When iron levels are too low, red blood cells are unable to form and consequently haemoglobin levels are low when red blood cells are low. Inadequate oxygen transport to reproductive organs such as ovaries can result in low-quality eggs; it can also impact the uterus and endometrial receptivity, making implantation and conception incredibly difficult. 

Furthermore, it has been found that if a woman is anaemic during her pregnancy, the risks of a premature birth increases and hence, low weight of the baby during birth can also be observed. 

The observations from the NFHS brings about conclusions beyond just the obvious. These are indicators of the overall health of Indians, and we must progressively work towards improving it.