Sharp decline in fertility rate rings alarm bells in J&K
If the trend continues, UT may have more dependent population than the working one in the future thus weakening the social fabric
While an alarming rate of infertility cases had already been noticed in Kashmir over the years; the National Family Health Survey (NFHS) data for 2019-21 has now confirmed a continuous and sharp fall in J&K’s Total Fertility Rate (TFR), an average number of children that would be born to a woman over her lifetime. In 1991, the TFR in Jammu and Kashmir was 3.6, which declined to 2.3 in 2007, and now, as per the latest NFHS data, the number stands at 1.4 only, the lowest in the country.
The revelation has rung alarm bells among the experts who say that the declining TFR trend might continue in the future as well, and it would have a long-term repercussion for the entire society. They say if the fall in TFR continues, Kashmir, in coming few decades, would have a much lesser young (working) population compared to the older (dependent) population, which would eventually weaken the social fabric of J&K.
Usually, the TFR of 2.1 is considered as an ideal ratio in terms of maintaining population growth in appropriate pace. As per the UN Population Division, a total fertility rate (TFR) of about 2.1 children per woman is called replacement-level fertility. If replacement level fertility is sustained over a sufficiently long period, each generation will exactly replace itself.
However, in case of J&K, the TFR is continuously falling. The drastic fall can be gauged by the fact that it has recorded decline of 0.6 in past five years, since the last NFHS survey in 2015-16. If the trend continues, experts fear, the present TFR of 1.4 might fall further in next five years. The reasons they cite for rising infertility and decline in the TFR include food adulteration, changing living patterns, late marriages and increased stress levels among men and women.
Also, some recent studies have indicated that Polycystic Ovarian Disease (PCOD), which could be a cause for infertility in women, is on the rise in Kashmir. Last year, a cross-sectional study done in the Valley found the prevalence of probable PCOS to be around 46.4% in women of reproductive age.
Some experts suggest that the Health and Family Welfare Department, which has been vibrantly working for population control and trying to ensure people pursue family planning, should now think to reverse its role to ensure J&K’s TFR does not fall further.
To understand the issue holistically, KASHMIR IMAGES spoke with some experts. Here are the excerpts:
Prof. Farhat Jabeen
Former HoD Obstetrics and Gynaecology, Government Medical College (GMC), Srinagar
We have been observing a decrease in fertility in Kashmir, over the years, due to multiple reasons. Stress, lifestyle changes, late marriages, obesity, and Polycystic Ovarian Diseases (PCOD) are some of them.
Take, for example, change in our lifestyle. In Kashmir, we had a different genetic makeup and different food habits. But our entire lifestyle including our food habits have completely changed over the years. Look at our adolescent population. Many of these kids are above 50 kgs of weight. That is because they are always inside the four walls busy with their phones. Earlier, children mostly would play outdoor keeping themselves active. Now they have no active life, and they eat large amounts of processed or junk food making them obese. Obesity is the mother of many diseases. It increases the risk of metabolic syndrome. Then, we have seen a rise in Polycystic Ovarian Diseases (PCOD) as well. This is also because of our changing food habits. PCOD leads to infertility in women.
Therefore, we need to change our lifestyle and food habits to ensure fertility is not affected. Parents must ensure that their children have healthy food and exercise on daily basis.
Above all, we need to avoid stress. Infertility is directly related to stress because stress affects the brain and the hormones in the body. Even it affects the proper functioning of the ovaries in women. Also, marriages should not be delayed. To put it briefly, I would say that we need to change our lifestyle and food habits for good to ensure fertility is not reduced further.
Dr. Javaid Ahmad
Endocrinologist
The latest data about the Total Fertility Rate (TFR) in J&K is quite alarming. J&K’s TFR has seen a sharp decline from 3.6 in 1991 to 1.4 now. It clearly shows a declining trend. There are a number of social and medical factors responsible for this decline. I think stressful life in Kashmir is one of the main reasons for reducing fertility. We live in an unconducive environment and most people are grappling with plenty of social and economic problems. Since it is a known fact that social, psychological, or physical stress causes a hormonal imbalance in an individual; constant stress could cause infertility or decline of fertility.
We know for sure that there are many known reasons for the decline in fertility in Kashmir. Sadly, we have been grappling with plenty of issues here. For instance, news reports pouring in suggest a good number of youngsters are smokers, and even some of them consume alcohol, and some consume different kinds of drugs. These things surely affect fertility. Our harmful lifestyle generates endocrine disruptors, which eventually cause infertility in men and women. Late marriage tendency, bad food habits, inactive lifestyle, stress, and so many other reasons cause a decline in the overall fertility rate.
Prof. Shahnaz Teng
Gynaecologist/Obstetrician; the former head of department Gynae,
Lal Ded Hospital, Srinagar
Fertility is declining in Kashmir. The recently revealed data also confirms Total Fertility Rate (TFR) decline in J&K. There are certain reasons for the decline of the fertility. But before I talk on any of them, let me tell you, by the way, that some married couples deliberately avoid fertilization thinking this world is not liveable. I asked a married couple why they avoid conception. They responded asking why they should bring a child in this cruel world. They were afraid that their child would have to grapple with the problems like, poverty, burden of education, unemployment, struggle for desirable life, uncertainty and violence around, and so on.
Now coming to the topic, I would say that there are a number of reasons for the growing infertility rate in Kashmir. However, I think late marriage tendency in our society is the key reason for decline in fertility. I remember that I have talked to ‘Kashmir Images’ in detail on this topic, last year. I would repeat and suggest the people must get rid of this late marriage trend. Late marriage is one of the major causes of infertility in women, simply because the biology in the business of reproduction favors men more than females. With aging, women get problems in conceiving. The best age for conception in females is between 18 and 28. After the age of 28, fertility naturally starts declining. Ovaries are the production house of eggs in women. These eggs get depleted after the age of late 20s and early 30s. After the age of 35, fertility begins to drop rapidly. Chances of conception becomes lesser and lesser. Even the eggs in the ovaries of the woman start aging with time and once the eggs are aged the chances of abortions are more during pregnancy. Even when aged women conceive, they are at increased risk of having babies with chromosomal abnormality. In such pregnancies, hypertension becomes more pronounced and dangerous. Some other pregnancy-related complicacies too occur because of the age factor of the woman.
We have seen that the average marriageable age has increased during the past few decades. Because, unlike the past, women pursue their higher education and career now, which is good. However, they should not let their education and career become a hurdle in their marriage; neither should their marriage become a hurdle in their pursuing education and career.
I have done my post-graduation after I got married and had children. My husband and in-laws supported me in pursuing higher education for a better career.
People should encourage women to pursue education and their career after they get married. Society has to change. Society cannot and should not be gender biased anymore. I personally have always been in favor of women’s education because I have seen what happens to the females who are dependent on their spouses for monetary assistance. But at the same time, I am not in favor of late marriages. Women need to maintain a balance between marriage and career.
Dr. Beenish Zohra
Clinical Nutritionist/ Dietitian; Research Scholar
It is verily true that food adulteration affects fertility in both men and women. The pesticide residues and the chemical containments in the food always mess up with the hormones of an individual. In fact, food adulteration is pushing the human race towards infertility.
In the context of Kashmir, I would say that we have some abnormal food habits that need to be changed. For example, the salt tea (noon chai) is usually over boiled and that too in aluminium pots in our homes. Further, we supplement our salt tea with baking soda to make it pink-colored. It becomes a carcinogen. I am not saying that we should not have salt tea, but the way we prepare it need to be changed to ensure it does not affect our health.
Then we have Maida Roti (supper-fined flour) from the Kandur (traditional baker). We must know that maida is refined, stripped off all the nutrients. We should opt for the homemade Rotis with multi-grain flour.
Similarly, we should avoid sun-dried vegetables (Hoek Suen) beyond a certain limit. It is not a healthy diet. Also, we must avoid consuming non-veg on daily basis. Eating non-veg in a large quantity causes gastric cancer, and it also might affect fertility. We must know that fat is good for health, but it should be the good fat only.
I would suggest that we should always try to eat an organic and high-fiber diet. I have observed that people in Kashmir mostly avoid fruits and vegetables, which is not good.
Moreover, in Kashmir, people usually do not have an ideal breakfast. For instance, a vegetable paratha, a bowl of oats, and a cup of milk make an ideal breakfast. Having an ideal breakfast in the morning will ensure that we will not crave for sugar and junk food all day.
I insist on a good diet because overall health and fertility are directly linked with what we eat. In 90 percent of cases, Polycystic Ovarian Disease (PCOD) is caused by bad food habits.
Furthermore, I would like to talk about lifestyle factors. An inactive lifestyle leads to obesity. And obesity hinders fertility. There is a specific range of Body Mass Index (BMI). If an individual does not fall in a particular and required BMI, his or her fertility capability can be affected.
To conclude, I would say that we must change our food habits and lifestyle for good to ensure our overall health and fertility does not get compromised. Parents must ensure their children eat a good diet and live an active life from the early stage of their lives. I say this because it becomes difficult to change our lifestyle and food habits in the later stages of our lives and by then most of the damage is already done.
Shaista Qayum
Assistant Professor (Sociology), Government Degree College, Baramulla
The rapid decline of the fertility rate should be a grave concern for everyone because it would eventually draw an adverse impact on our entire social fabric. If the decline continues, the time will come when we will have a more dependent population than the working population. And this population imbalance would open the gates for certain social adversities like domestic violence, divorces, suicides, cruelty against women and elderly people, and so on.
To get it, we first need to understand the fundamental structure of our society. Marriage is the most important institution of society and the key purpose of marriage is the production and nurturing of children. Children are assets to the parents, mostly because they usually are the support for old age. The continuous reduction in fertility rate means that we would need to open old age homes here in the future. Rising infertility might also cause cruelty against the woman folk simply because infertility is always attributed to the women in our society. I know a childless couple who had got tied in the nuptial knot in 2000, and the wife was forced to go door to door to the doctors and peer faqeers (supposedly spiritual gurus) to treat her ‘infertility’ till 2017 when a medical test confirmed that the problem actually was with the husband. As an expert in sociology, and a keen observer I can tell you that infertile women are treated as a bad omen in our social gatherings. That is why I say that declining TFR would eventually increase the insensitivity against women in our society.
In the larger context, rapid fertility decline would impact overall social framework. Any population theorist would tell you that the way population explosion in any country could lead its people to scarcity of resources; the scarcity of the working population causes the inability to explore and avail advantages of the resources. Take for example the African countries, which are full of resources, yet grappling with poverty. They have huge natural resources but an insufficient working population to explore these resources. These countries fall in the third world category only because they have a more dependent population than the working population. For any nation, the balance between old age and the young population is of utmost importance. That is why China is now rolling back its ‘one-child policy’. Its dependent population has overshadowed the working population with grave repercussions.
Therefore, the pattern that shows a constant decline in J&K’s TFR should be a matter of concern for everyone. The fertility rate up to an optimum level is a blessing for human societies; and the decline in fertility rate beyond a limit can be a curse for societies.
Dr. Saleem-ur-Rehman
Director General, Family Welfare, MCH and Immunization, J&K
I do not see any problem in the decline of the Total Fertility Rate (TFR) in Jammu and Kashmir. I, rather, would say that it is a good sign in terms of population control. In fact, our department, besides trying to reduce maternal and infant mortality rate, has been working to bring down the TFR as well. And now we have got the result of our job. We have succeeded.
We should be happy that our TFR is as good as of the Scandinavian countries like Denmark, Finland, Sweden, and so on. These countries are smaller and with much lesser populations, if compared to UT of J&K; yet they have ensured their TFR does not go up.
We must understand that overpopulation generates a bad quality of life. Therefore, our present TFR indicates that people prefer a good quality of life.
The decline in our TFR is not something that has been intimated. It is rather something that has come upon as voluntarily by the people, thanks to the rising literacy rate in our society. We should not forget that, in given resources, we are already overpopulated, and our resources are receding. Therefore, it is good that our TFR has gone down. In our available resources, quality of life can only improve if the population is less. The rise in population means environmental degradation and compromise on resources.
Moreover, I must tell you that people earlier used to have more children because they had no faith in the health care delivery system. They would have more children because many of them would die due to the lack of health care system. In those days, we would have 45 to 50 infant deaths per 1,000 live births. Now, our infant deaths have reduced to 13 per 1000 births. Similarly, we used to have up to 150 maternal mortalities per 1000 deliveries, which have been reduced to 46 now. We have succeeded to institutionalize our delivery system. Likewise, we have developed a good immunization mechanism over the years. Presently, our immunization rate pegs at 96 percent. This improvement in health care structure has built up people’s faith in the system, and eventually, they go for fewer kids now. Let me reassure you that the present TFR in J&K would help to stabilize the population ratio in the future.
