Why solving the fertility crisis needs public-private muscle

The United Nations Population Fund's 2025 report, The Real Fertility Crisis: The Pursuit of Reproductive Agency in a Changing World, was published on 10th June 2025 and challenges the long-standing global anxiety around fertility rates falling too fast. However, the real crisis, as the report argues, is not that people are having fewer children, but that they are unable to have the number of children they want. From rising living costs and inaccessible fertility care to rigid workplaces and outdated gender roles, millions today are trapped between desire and reality.
In India, this gap is becoming increasingly visible, as with a Total Fertility Rate (TFR) of 1.9, the country is now below replacement levels while still grappling with wide disparities across states and socioeconomic groups. According to the report, 36% of pregnancies in India are unintended, and nearly one in three adults report not being able to meet their fertility goals. This is where a stronger ecosystem could prove critical: one that leverages public-private partnerships (PPPs) to not only expand services but also dismantle structural barriers. If governments, private health providers, and employers worked in tandem to improve access, affordability, and awareness, it could mark a significant shift in how reproductive health is understood and supported.
But for that to happen, corrective measures must go far beyond financial incentives or pronatalist messaging. As the report emphasizes, the real solution lies in restoring agency and ensuring people have the ability to make informed, supported choices about if, when, and how to have children. This means universal access to contraception, affordable fertility treatments, workplace policies that recognize caregiving, and reliable childcare infrastructure. And here, private sector participation could be pivotal. IVF clinics, fertility tech platforms, diagnostic labs, pharma companies, and insurance firms, aligned with public health goals, can bridge critical care gaps. For example, co-developing fertility insurance plans, launching workplace fertility wellness programmes, or expanding fertility services to Tier 2 and 3 cities through PPP models could ensure reproductive health is not just a privilege for the urban few.
Speaking to Abhishek Aggrawal, CEO, Birla Fertility & IVF, he shares, "The report offers an important lens on fertility, not just as a health statistic, but as a matter of agency, equity, and timely access. The challenge before us is the growing gap between people's aspirations and their ability to act on them, often due to late diagnosis, limited support, and constrained choices. This is where policy and partnerships must evolve. Fertility care needs to be integrated into how we think about public health: not as a specialized service for a few, but as preventive, inclusive care for all. That means awareness at the grassroots level, timely screenings, equitable access to assisted reproduction, and proactive fertility preservation, especially for those most at risk of being left out. For us, commitment to making this shift happen is of great importance, and hence we advocate for workplace reproductive wellness clinics and corporate fertility workshops to help individuals make informed decisions without stigma or delay. Bridging the gap between aspiration and access requires coordination across public health, private care, and the workplace. ecosystems. That is the call to action this report makes clear. And it is one we must all respond to with urgency, openness, and long-term commitment."
While much of the fertility debate often centres around statistics and population projections, the report makes it clear that women's reproductive health lies at the heart of the crisis. Women are disproportionately affected by caregiving responsibilities, workplace discrimination, and stigma around delayed motherhood. Many report postponing or abandoning plans to start families due to career penalties, housing insecurity, or lack of partner support. The report also notes that unmet contraceptive needs, unsafe abortions, and delayed fertility diagnoses remain pressing challenges, especially in lower-income or rural settings.
Mr. Sombrata Ray, Unit Head, CK Birla Hospitals, CMRI, reflects these concerns and expands on the need for timely intervention, stating, "Indeed, millions of families go through emotional, financial, and physical consequences of either a lack of timely information or support. Even more concerning is the fact that many unintended pregnancies are largely preventable. This signals a huge gap in reproductive awareness, availability of contraceptives, and open communication about family planning. Public and private healthcare systems must come together to take adequate measures. We need to make greater investments in community education, increase access to contraceptive counseling and fertility support, and make reproductive health services accessible to both men and women in both urban and rural communities. A free cervical cancer vaccination camp is an additional component of the CMRI's commitment to women's health, which vaccinates young girls and women against HPV, one of the main causes of cervical cancer. When delivered early and in an equitable manner, preventive care can, in many cases, reduce the long-term disease burden and save many lives."
Ultimately, the report's message is not to alarm but to create a sense of urgency. People want to start families, but too many are constrained by circumstances they cannot control. Fertility is no longer just a personal decision. Today, it is a public issue, a workplace issue, and a societal one, and tackling it will require the kind of cross-sector collaboration that puts people's choices at the center.

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