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Does low fertility indicate better reproductive health status? Evidence from nationally representative survey in India

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  • Roni Sikdar
  • Dhananjay W Bansod

Abstract

Background: The global demographic landscape is experiencing a significant transformation of declining fertility rates, which has far-reaching implications for societal development and women’s well-being. The study investigates the association between declining fertility rates and women’s reproductive health in India, considering socioeconomic and demographic factors as well as regional variations. Methods: The study uses data from the recent National Family Health Survey (NFHS-5) round conducted during 2019−21. A composite index called the Reproductive Health Index (RHI) is constructed by equally weighing indicators such as antenatal care, anemia, and body mass index. To evaluate the robustness of this index, a sensitivity analysis is performed. Descriptive statistics and Poisson regression models are employed to explore the association between fertility and RHI among currently married women. Results: The findings show substantial differences in RHI scores across socio-economic, demographic groups, and geographical regions. The lowest RHI score of 4.09 is found in the Eastern region, whereas those in the Northern region exhibit the highest score of 4.42. The analysis further indicates a negative relationship between fertility and reproductive health. Women with four or more children exhibit an RHI score of 1.97 compared to 2.98 among those with one child. The Poisson regression analysis indicates that women with at least four children have lower RHI scores, even after adjusting for socio-economic and demographic factors. Women in wealthier quintiles and those with media exposure report significantly higher RHI score compared to those in the poorest wealth quintiles and no media exposure. Conclusion: In conclusion, this research highlights the critical need for targeted interventions to address regional and socio-economic inequities in healthcare access and reproductive health services. By exploring the intricate relationship between low fertility and reproductive health, this study contributes to the discourse on gender equality, reproductive rights, and sustainable societal development. The findings provide evidence to guide public health policies and programs designed to promote women’s reproductive health.

Suggested Citation

  • Roni Sikdar & Dhananjay W Bansod, 2025. "Does low fertility indicate better reproductive health status? Evidence from nationally representative survey in India," PLOS ONE, Public Library of Science, vol. 20(8), pages 1-15, August.
    • Handle: RePEc:plo:pone00:0329375
    DOI: 10.1371/journal.pone.0329375
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    References listed on IDEAS

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    1. Bloom, David E. & Canning, David & Sevilla, Jaypee, 2004. "The Effect of Health on Economic Growth: A Production Function Approach," World Development, Elsevier, vol. 32(1), pages 1-13, January.
    2. Elizabeth Brainerd, 2014. "Can government policies reverse undesirable declines in fertility?," IZA World of Labor, Institute of Labor Economics (IZA), pages 1-23, May.
    3. repec:ilo:ilowps:486789 is not listed on IDEAS
    4. repec:iza:izawol:journl:y:2014:p:23 is not listed on IDEAS
    5. Chaudhary, Ruchika. & Verick, Sher., 2014. "Female labour force participation in India and beyond," ILO Working Papers 994867893402676, International Labour Organization.
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