India’s silent demographic shift: Falling fertility and looming socio-economic impact

India is in the midst of a quiet but profound demographic shift. Once preoccupied with curbing population growth, the country is now grappling with declining fertility rates across both urban and rural regions.

According to the United Nations Population Fund (UNFPA), India’s Total Fertility Rate (TFR) has already dipped below the replacement level of 2.1 in several states, and is projected to fall to 1.29 by 2050. This means that nearly one in five Indians will be over 60 years old by mid-century, placing immense strain on healthcare, social security and the economy.

Dr. Monika Gupta, Head of Kailash IVF at Kailash Hospital, said the shift is no longer limited to cities but has reached rural India, where large families were once central to social and economic life.

“Fertility rates in rural and urban India are falling. What was initially driven by lifestyle change, education, and urbanization now affects rural India as well, traditionally tied to the culture of large families, and is recording fertility rates below replacement levels in several states,” she explained. She warned that the trend could destabilise agricultural labour in villages while urban India faces a rising burden of infertility linked to stress, pollution and medical conditions.

Dr. Nishi Singh, Head of Prime IVF, echoed these concerns, stressing that the demographic transition signals more than just family planning success. “India’s fertility rates are falling steadily across both rural and urban regions, indicating a crucial demographic shift,” she said.

“By the 2040s, the country could be experiencing labour shortages, increasing older-age dependency, and higher demands on medical care, social support, and pension systems.” She also pointed to elevated death rates persisting since the pandemic, with crude death rates in 2025 still higher than pre-Covid levels. For her, the decline is an “alarm call” demanding anticipatory policies, ranging from stronger reproductive healthcare to affordable universal pensions.

Doctors say that beyond demographic trends, lifestyle habits are playing an equally decisive role in shaping fertility and menstrual health. Dr Gauri Agarwal, fertility specialist and founder of Seeds of Innocens, highlighted how poor diet, stress, smoking, alcohol use, and weight extremes can disrupt hormones, leading to irregular periods, painful cycles, or conditions like PCOS.

“With the right lifestyle choices, women can not only regulate their cycles but also improve their chances of a healthy pregnancy,” she said, urging regular health check-ups and balanced habits.

Dr. Swati Sinha, Senior Consultant in Obstetrics and Gynaecology at Rainbow Children’s Hospital, Delhi, underscored that even small, everyday choices add up. “Eating a balanced diet helps regulate hormones that control your period and ovulation,” she explained. “Exercise is important, but overdoing it can lead to missed periods. Stress is another big factor; chronic stress can interfere with the brain signals that regulate your cycle.”

Similarly, Dr. Tripti Raheja, Director of Obstetrics & Gynaecology at the CK Birla Hospital, pointed to the benefits of nutrient-rich diets, mental health practices, and moderate exercise. “Maintaining a healthy weight and exercising regularly lowers insulin levels and helps with the regular release of eggs from the ovaries,” she said, cautioning that processed foods, trans fats, poor sleep, and smoking can worsen hormonal imbalances and impair conception.

Expanding on these concerns, Dr. Rupali Mishra, Sonologist & Founder of Dr. Rupali’s Abortion Centre, warned that excessive reliance on digital technology and sedentary routines is having a deeper impact on women’s reproductive health.

“It is a reality that digital technology, social gadgets and the internet have made life fast and convenient, but the excess use of social media and mobile devices has led to serious health concerns like obesity, infertility, and menstrual health issues,” she said.

She also said that obesity among young girls and women often results in irregular cycles, PCOD, endometrial diseases and future infertility, with high-fat diets, smoking, alcoholism and environmental pollution adding to the risk. “Another worrying trend is that due to irregular cycles, many young women fail to recognise pregnancy symptoms until very late. Since abortion is not permitted after 24 weeks in India, some turn to unsafe methods, which can be life-threatening,” she cautioned. Dr Mishra emphasised that regular

Taken together, the experts’ insights suggest India faces a dual challenge: managing a rapidly ageing population while addressing lifestyle-driven infertility in younger generations. Policymakers, they argue, need to move beyond population control towards comprehensive fertility health, encompassing maternal care, reproductive treatment access and social support systems that balance modern aspirations with biological realities.