ISLAMABAD: India's fertility rate has fallen below the 2.1 replacement threshold necessary to sustain the population, even as the country faces a rising epidemic of obesity and metabolic diseases among working-age adults.
According to the National Family Health Survey released by the Ministry of Health and Family Welfare, the total fertility rate stands at 2.0 children per woman, a critical marker of a demographic crisis that could cripple economic growth within decades. In urban areas, the collapse is steeper: women are having just 1.5 children on average, compared to 2.1 in rural regions. Delhi has dropped to 1.2, the lowest in the country, while Bihar remains highest at 3.0.
The decline reflects widespread contraceptive adoption, driven largely by female sterilization. In urban areas, 69% of women use contraception, with 41% relying on permanent sterilization. Rural contraceptive use stands at 66%, similarly dominated by sterilization.
Meanwhile, high blood sugar among women aged 15 to 49 rose to 18% from 14%, while the rate among men climbed to 21% from 16%.
Overweight and obesity now affect 31% of women and 27% of men in the same age group. Hypertension declined slightly: women to 19% from 21%, and men to 22% from 24%.
The data also reveals infertility issues in Indian women. Between 2% and 3% of married women face primary infertility, while secondary infertility affects 13% to 14% of couples, suggesting fertility decline stems not solely from contraceptive choice but also from biological and health barriers.
India now confronts two simultaneous crises: pressures on its already bloated healthcare system and the economy. Falling fertility rates will reduce demand for maternal and child health services while shrinking the working-age population that funds and staffs those systems.
Meanwhile, rising rates of obesity, high blood sugar, and metabolic disease among working adults will increase demand for chronic disease treatment and management, straining healthcare infrastructure.