Could fertility literacy be the missing piece in India’s reproductive health journey?

India has made remarkable progress in reproductive healthcare-from reducing maternal mortality and expanding access to contraception to strengthening healthcare infrastructure. Yet the next phase of progress will depend not only on expanding access to care, but also on strengthening fertility literacy. As per the World Health Organisation, almost one out of every six individuals faces issues related to infertility in their life. Further, as per the State of World Population 2025 report published by UNFPA, 30% of the adult population in India is not able to have their desired number of children, and 36% have faced an unplanned pregnancy. Together, these numbers point to a simple reality: reproductive choices are increasingly being shaped by knowledge gaps as much as medical challenges.

 In light of increased education, urbanisation, female employment in the workforce, and financial desires, individuals have decided to have children later in their lives. Even though the decisions being made are a positive move, they put increased importance on reproductive health knowledge. The ability to conceive depends on an individual's age, general state of health, and personal lifestyle; unfortunately, these conversations often happen only when someone decides to conceive, rather than much earlier when they can have the greatest impact on reproductive choices.

 Growing discrepancy between knowledge and action

The challenge today is no longer just access to reproductive healthcare but to ensure that people have the knowledge to act early enough to benefit from it. Many people only realise the impact of reproductive ageing, lifestyle, and medical history on their fertility once they experience problems themselves. This is a time factor that may reduce available choices even when medicine progresses.

 Fertility literacy is not only knowledge about assisted reproductive techniques. Fertility literacy covers the knowledge that age impacts fertility, the knowledge of the role of PCOS, endometriosis, thyroid issues, and male factor infertility, knowledge of how nutrition, weight issues, smoking, stress, and environment impact fertility status, and when to consult a specialist. One key feature of fertility literacy is its focus on infertility being an issue related to women and men at the same time, not just women's.

Timing is still critical

Technological breakthroughs have revolutionised the field of reproductive science. With fertility preservation, embryo testing, genetic knowledge, digitisation and individualised treatments becoming more effective and accurate. Yet it is in the earliest stages that such technology becomes most useful. Current clinical recommendations advise fertility evaluation after 12 months of regular unprotected intercourse without conception, or after six months if the woman is over the age of 35. Earlier intervention expands treatment choices and improves the likelihood of successful outcomes, whereas no technological advancement can fully reverse the natural effects of reproductive ageing. Fertility literacy therefore becomes the bridge between medical advances and timely action.

Moving fertility into preventive healthcare

This is why fertility deserves to be recognised alongside other preventive health priorities. Fertility literacy should no longer be viewed only as part of infertility care. It should become an integral part of preventive healthcare. Just like testing for diabetes, heart disease, and cancers is now an essential part of routine health care, being aware of fertility must be an important aspect of prevention. If fertility education becomes a part of primary healthcare, office-based wellness programs, university health centres, and even online health portals, people can make informed choices even before any problems arise with their fertility.

 It is equally crucial to create an environment that fosters such a move. Clinicians, scientists, employers, educators, policy makers, and patient groups can all contribute to making scientific and evidence-based reproductive health information easily available.  Digital health platforms can further strengthen this effort by making evidence-based information, early screening and specialist guidance more accessible and personalised.

 The future of reproductive medicine

India's next milestone in reproductive healthcare will not be defined only by new treatments or better technologies. It will be defined by how early people are empowered with the knowledge to make informed reproductive choices. As precision medicine, genomics and digital health continue to reshape reproductive medicine, fertility literacy will become the foundation that allows these advances to create meaningful impact. Ultimately, strengthening fertility literacy is about far more than improving access to treatment. It is about enabling informed choices, supporting healthier families, advancing women's health and strengthening India's long-term public health outcomes.

The author is the country speaker, Merck India and Managing Director, Merck Specialities Pvt. Ltd.

The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.