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Business Standard
5 hours ago
- Health
- Business Standard
IVF players on expansion mode in smaller towns as fertility rates go down
Major in-vitro fertilisation (IVF) chains are expanding into untapped Tier 2 and 3 cities, driven by improved healthcare infrastructure, growing acceptance of fertility treatments, and rising disposable incomes in smaller urban centres. Birla Fertility and IVF, which currently operates around 30 centres in Tier 2 and 3 cities, plans to open at least 15 to 16 more centres in FY26, two-thirds of which will be in smaller towns. Nova IVF, which derives 40 per cent of its revenue from such cities, is exploring expansion in 15 locations including Haldwani, Jamnagar and Meerut. Indira IVF, the country's largest infertility chain, has also announced plans to enter over 25 Tier 3 cities by FY27. Explaining the rationale, Shobhit Agarwal, Chief Executive Officer (CEO) of Nova IVF Fertility, said, 'With one in six couples experiencing infertility in India, there is a need for fertility chains to expand to cater to couples battling infertility.' A recent United Nations Population Fund (UNFPA) report highlighted that India's total fertility rate (TFR) has fallen to 1.9 births per woman — below the replacement level of 2.1. The report echoes findings from the National Family Health Survey (NFHS)-5, which pegged India's TFR at 2.0 births per woman for 2019–21. The NFHS-5 also found the fertility rate had declined more significantly in rural areas, where it stood at 2.1 — down from 3.7 in NFHS-1 (1992–93). In urban areas, it fell to 1.6 from 2.7 in the same period. While infertility is not the sole factor behind the falling TFR, experts suggest infertility cases are expected to rise beyond Tier 1 cities, fuelled by stress-related lifestyle diseases and climate change. Industry insiders say IVF players are already witnessing increased demand for infertility treatment from Tier 2 and 3 cities. Abhishek Aggrawal, CEO of Birla Fertility and IVF, told Business Standard that more than 50 per cent of the company's annual IVF cycles are conducted in cities such as Siliguri, Varanasi and Prayagraj. 'While there is a rising segment in metros, with IVF chains receiving queries from women for procedures like egg freezing to delay parenthood, Tier 2 cities are providing an opportunity to tap less penetrated, high-potential markets,' he said. Agarwal added that many couples from Tier 2 regions find it difficult to travel to larger cities for fertility treatment, as the cost of travel, accommodation and lost wages makes the process financially burdensome. 'With expansion, we are bringing standardised fertility treatment to their home towns, with the best clinical acumen and embryologists,' he said. This model, he added, is affordable and avoids additional hassle. India currently performs around 200,000 to 250,000 IVF cycles annually, and the market is projected to grow to 400,000 cycles by 2030, with smaller cities expected to account for a substantial share of this growth. Aggrawal noted that to meet this growing demand, IVF chains are also focusing on building awareness to ensure fertility care is both accessible and better understood by those in need.
The Hindu
4 days ago
- Health
- The Hindu
Changing mindsets and narratives around obesity for a healthier future
A 42-year-old schoolteacher once told me she had tried everything: eating less, walking daily and yet, saw no change on the weighing scale. Like millions across India, she blamed herself, believing her weight to be a personal failure rather than a medical issue. She is not alone. In India, obesity is still seen as more a cosmetic concern than a medical one. People suffering from obesity are told to eat less, move more, and try harder. What they are rarely told is that obesity is a chronic disease that involves genetics, hormones, mental health, and the environment. And like any disease, it requires real treatment, not judgement. Obesity on the rise Globally, obesity is on the rise, and it is projected that without immediate action, around a third (746 million) of the world's children and adolescents will be overweight or obese by 2050. Despite the numbers, public perception hasn't caught up with medical science. We continue to treat obesity as a character flaw rather than a condition that deserves clinical attention. That mindset is dangerous: it is time to change how we talk about obesity and treat it like the chronic disease it is. Also Read: Why obesity in children is a growing concern in India India is also facing an obesity epidemic. The National Family Health Survey (NFHS-5) classified 24% of women and 23% of men as overweight/obesity, a sharp rise from previous years. This trend shows no sign of slowing down. More than 440 million Indians are projected to be overweight or obese by 2050. Moreover, obesity is no longer confined to urban elites. It is growing rapidly in rural areas and lower-income populations, driven by urbanisation, increased access to processed foods, sedentary jobs, and lifestyle changes. This epidemic is not just about body size. It is about the surging rates of non-communicable diseases (NCDs) like diabetes, cardiovascular disease, and hypertension, which now account for 63% of all deaths in India.i Why mindset matters Obesity management is not just about calorie measurements. It involves complex interactions between genetics, hormones, brain chemistry, environment, and behavior. People living with obesity often find that their bodies resist weight loss, not because of a lack of discipline, but because their biology fights it. The challenge can be almost insurmountable and is further impeded by complications brought on by the disease. Only 20% of individuals with obesity can maintain their weight loss, long-term. Despite this, the dominant narrative in India takes a simplistic and judgemental perception. It equates weight gain with laziness, and weight loss with virtue, and this stigma shows up in every societal conversation. Many still see obesity as a sign of prosperity, a harmless cosmetic issue, or, conversely, a moral failing. This mindset creates several problems including preventing people from seeking professional help and ignoring the complex interplay of biology when it comes to weight. Obesity and mental health are also deeply interconnected, often creating a vicious cycle that is overlooked. Individuals living with obesity frequently face stigma, discrimination, and negative body image perceptions, all of which can lead to low self-esteem, anxiety, and depression. The emotional distress caused by societal judgment can, in turn, contribute to unhealthy eating patterns, reduced motivation for physical activity, and social withdrawal. Moreover, mental health conditions like depression may also influence biological factors such as hormone levels and metabolism, further complicating weight management. Addressing obesity, therefore, requires a compassionate, holistic approach that considers both physical and mental well-being, rather than focusing solely on weight loss. Changing the narrative Changing the narrative means recognising obesity as a chronic disease influenced by factors beyond individual willpower. It requires empathy, science-based understanding, and collective action. Databases must include a fuller picture of the individual's health-care status. Furthermore, there is substantial scope for stratification of clinical obesity into different subtypes, potentially based on their clinical presentation or pathophysiology By embracing a more empathetic, science-based approach, and implementing comprehensive public health strategies, India can hope to stem the tide of this growing epidemic and ensure a healthier future for its citizens. (Dr. Ramen Goel is director, bariatric & metabolic surgery, Wockhardt Group of Hospitals, Mumbai. ramengoel@
Time of India
11-06-2025
- Health
- Time of India
Post-natal gaps in C-section deliveries leading to breastfeeding challenges for women, say experts
Lucknow: Neha Singh (name changed), 25, from Unnao, underwent a cesarean delivery at a private hospital but couldn't breastfeed her newborn son. Despite multiple attempts on the first day, the baby failed to latch properly. Doctors advised formula milk, which led to constipation in the infant and anxiety for the new mother. The next day, Neha's family took her to a private medical college, where doctors explained that the delayed initiation of breastfeeding had disrupted the baby's natural latching instinct, affecting her milk production. With proper counselling and lactation training, Neha was able to begin breastfeeding within two days. "I had no idea that timing and guidance were so important. I wish someone had explained this to me earlier," she said. Neha's experience is not uncommon in new mothers. Doctors at govt and private teaching hospitals in the city say many women who deliver via C-section in private hospitals struggle to breastfeed. The issue, they emphasise, often lies not with the surgery, but with poor postnatal care and hospital practices. Sponsored Links Sponsored Links Promoted Links Promoted Links You May Like 5 Books Warren Buffett Wants You to Read In 2025 Blinkist: Warren Buffett's Reading List Undo Hospitals like King George's Medical University (KGMU), Era's Medical College, and Dr Ram Manohar Lohia Institute of Medical Sciences (RMLIMS) report seeing 10–12 such cases every month. In most instances, mothers delivered at other hospitals and approached these centres only after facing problems such as poor milk supply, failure to latch, or early dependence on formula feeding. According to the National Family Health Survey (NFHS-5), the rate of cesarean deliveries in Uttar Pradesh more than doubled—from 9.4% in 2015–16 to 21.5% in 2019–21—with most procedures taking place in private hospitals. While many mothers report breastfeeding difficulties after C-sections, doctors insist the underlying problem is how newborns are handled immediately after birth. "Cesarean surgery itself doesn't hamper breastfeeding," said dean of Era Medical College and senior paediatrician, Prof MM Faridi. "The real problem is that in many hospitals, babies are separated from their mothers for long hours and are bottle-fed. This leads to nipple confusion, which makes breastfeeding much harder," he added. Early skin-to-skin contact and breastfeeding within the first hour of birth are crucial. The baby's suckling stimulates maternal hormones—prolactin and oxytocin—essential for milk production. However, many hospitals skip these steps. The absence of trained nurses and lactation consultants only worsens the problem. Prof Faridi advocates for mandatory lactation training and strict implementation of the Baby-Friendly Hospital Initiative (BFHI), which recommends keeping mother and baby together to encourage early breastfeeding. At KGMU, Prof Amita Pandey said, "In most C-section cases, we start breastfeeding even during surgery. Although mothers can take only oral fluids in the first 12 hours, milk production begins almost as it does in normal deliveries." Prof Smriti Agrawal of Queen Mary's Hospital stressed the importance of initiating breastfeeding within the first hour.
Time of India
04-06-2025
- Health
- Time of India
Child marriage rate in Jharkhand registers dip, betters nat'l average: Govt
Ranchi: There has been a visible improvement in the fight against child marriage, with the state registering a 5.7% decline in child marriages, outpacing the national reduction of 3.5%, as per the latest National Family Health Survey (NFHS-5), the Jharkhand IPRD department stated. Tired of too many ads? go ad free now According to the women and child development department, the progress is attributed to the effective implementation of welfare schemes like the Savitribai Phule Kishori Samridhi Yojana (SPKSY) and Beti Bachao Beti Padhao (BBBP), which continue to drive social change by focusing on education, awareness, and the empowerment of adolescent girls. The rate of marriage below the age of 18 years dropped from 37.9% in NFHS-4 (2015 to 2016) to 32.2% in NFHS-5 (2019 to 2021). Under the SPKSY, the state govt provided financial assistance of over Rs 424 crore to more than 7.36 lakh girls in the financial year 2024–25. Director of women and child welfare department, Kiran Kumari Pasi, said, "The drop in child marriage rates is a strong indicator that our awareness campaigns and education-focused initiatives are making a real difference on the ground. Through schemes, the govt is empowering our daughters to pursue education, delay marriage, and build brighter futures." That apart, the state also progressed in maternal health. According to the May 2025 bulletin of the Sample Registration System (SRS), the maternal mortality rate in the state dropped from 56% to 51%. The govt also met its target of a 2% annual increase in the sex ratio over the last two years for gender equity. The department also provided 10,800 gift kits to new mothers, reinforcing the message of valuing girl children. Tired of too many ads? go ad free now The Beti Bachao Beti Padhao scheme, operational in all districts since 2023, further strengthened these outcomes. Over 50,000 awareness activities were conducted by the social welfare department, reaching more than 10 lakh children and parents. Pasi said, "These efforts focused on crucial issues such as prevention of female foeticide, promotion of institutional deliveries, pregnancy registration, school enrolment and re-enrolment of girls, menstrual hygiene, and skill development. "
Hans India
03-06-2025
- Health
- Hans India
Pregnancy Anemia linked to Congenital Heart Defects in New Born
Bengaluru: Anemia is a major global health concern, particularly affecting women of childbearing age, with prevalence rates between 20–40%, translating to over 500 million individuals worldwide. It is especially significant during pregnancy, where it can lead to complications for both mother and baby. The primary cause is iron deficiency, responsible for over half of the cases. In India, the situation is particularly alarming, with the National Family Health Survey-5 (NFHS-5) reporting that approximately 52.5% of pregnant women are affected by anemia. Addressing this issue involves improving nutritional intake, promoting iron supplementation, and implementing public health strategies to reduce the burden of anemia globally and within specific populations like India. Increased Requirement of Iron during pregnancy: During pregnancy, there is an increased need for iron to support the developing fetus and to accommodate the mother's expanding blood volume. Iron is essential for producing hemoglobin, the protein in red blood cells responsible for transporting oxygen throughout the body. Adequate iron intake ensures sufficient hemoglobin levels, which are critical for oxygen delivery to tissues and organs. As pregnancy progresses into the second and third trimesters, the demands for iron and vitamins become even higher. If these increased nutritional needs are not met, it can lead to iron deficiency anemia. This condition occurs when iron intake falls short of the body's requirements, resulting in fewer red blood cells and decreased oxygen transport. Managing iron intake through diet and supplementation is vital during pregnancy to prevent anemia and support the health of both mother and baby. Challenges of anaemia during pregnancy During pregnancy, there is an increase in blood volume—more than the increase in blood cells—leading to a condition known as hemodilution. This process helps ensure adequate blood flow to the developing fetus but can sometimes be mistaken for anemia. However, anemia in pregnancy is diagnosed when hemoglobin levels fall below 10.5 g/dL. Anemia poses several risks for both mother and fetus. For the mother, low hemoglobin levels can cause symptoms such as fatigue, weakness, and difficulty performing daily activities. In severe cases, it may lead to breathlessness and cardiac issues. For the fetus, maternal anemia can result in restricted growth (growth restriction or IUGR), low birth weight, and may affect placental development. Poor placental function is linked to complications like pre-eclampsia and gestational diabetes. Managing anemia effectively during pregnancy is crucial to reduce these risks and ensure better outcomes for both mother and child. New Evidence: Link to Congenital Heart Defects A recent study published in the British Journal of Obstetrics and Gynaecology highlights an even more concerning association. Researchers analyzed health records of women in the UK who became pregnant between January 1998 and October 2020, and found that anemia during pregnancy was linked to a 40–47% higher risk of the child being born with congenital heart defects. This finding suggests that maternal anemia may interfere with early fetal cardiovascular development, adding another dimension to the importance of timely diagnosis and treatment. Maternal Complications of Anemia Anemia affects a pregnant woman's health and resilience, particularly during labor and postpartum recovery. Key complications include: ● Fatigue and reduced physical capacity ● Increased susceptibility to infections, especially urinary tract infections (UTIs) ● Postpartum hemorrhage (PPH): Low hemoglobin levels reduce the body's ability to tolerate blood loss, increasing the risk of severe bleeding during or after delivery ● Need for blood transfusion: To restore hemoglobin levels in cases of significant blood loss ● Abnormal blood clotting: Severe anemia and blood loss can trigger Disseminated Intravascular Coagulation (DIC), a life-threatening condition where the blood's clotting ability becomes dysregulated What Are Congenital Heart Defects (CHDs)? Congenital Heart Defects (CHDs) are structural abnormalities of the heart that are present at birth. These defects can affect the heart's walls, valves, or major blood vessels, disrupting normal blood flow through the heart and to the rest of the body. CHDs range in severity: ● Mild cases may go unnoticed at birth and resolve on their own or require minimal treatment. ● Severe defects can be life-threatening and often require early surgical intervention or ongoing cardiac care. CHDs: A Major Public Health Concern ● CHDs are among the leading causes of infant morbidity and mortality worldwide. According to data published in Indian Pediatrics, approximately 180,000–200,000 children are born with congenital heart disease each year in India alone. Unfortunately, a significant number of these cases remain undiagnosed or untreated, especially in rural and low-resource settings. Risk Factors for Anemia During Pregnancy Several pre-existing conditions and pregnancy-related factors can increase a woman's risk of developing anemia during pregnancy. Identifying these early allows for timely intervention and better outcomes for both mother and baby. Key Contributing Factors: 1. Hyperemesis Gravidarum o Severe and persistent nausea and vomiting during pregnancy o Leads to poor nutritional intake and dehydration, contributing to iron and folate deficiencies 2. Pre-existing Anemia ● Women with iron-deficiency anemia before conception are more likely to experience worsened anemia during pregnancy ● Often linked to poor dietary intake or chronic malnutrition 3, Congenital Hemoglobinopathies ● Conditions like thalassemia or sickle cell disease can cause chronic anemia, which may be exacerbated by pregnancy 4. Multiple Pregnancies ● Carrying twins or higher-order multiples increases demand for nutrients, especially iron and folic acid, heightening anemia risk 5. Short Interpregnancy Intervals ● A reduced gap between pregnancies can prevent the body from replenishing iron and nutrient stores, increasing susceptibility to anemia 6. Gynecological Conditions o Women with heavy menstrual bleeding due to conditions like fibroids or endometriosis may begin pregnancy with already low iron stores The Importance of Iron in Fetal Heart Development Iron plays a crucial role in the early development of the fetal heart. During embryogenesis, the heart is the first functional organ to begin forming—starting as early as the 7th week of gestation. On early ultrasound scans, this is often visualized as a faint pulsation, marking the onset of cardiac activity. However, the process of heart development begins even earlier and involves a highly coordinated sequence of events: Key Stages of Fetal Heart Formation: 1. Formation of Primitive Blood Vessels 2. Cardiac Looping – where the heart tube folds into its basic shape 3. Septation – the formation of walls (septa) separating the heart chambers 4. Chamber Differentiation – development of the four-chambered structure seen after birth These stages are highly sensitive to oxygen levels and nutrient availability, especially iron, which is vital for: ● Hemoglobin production (oxygen transport) ● Cell division and differentiation ● Mitochondrial energy metabolism needed for organ development Impact of Maternal Anemia on Fetal Cardiac Development When a pregnant woman is anemic, her blood carries less oxygen to the placenta and fetus. This hypoxic environment can interfere with the delicate processes involved in early heart formation, increasing the risk of congenital heart defects (CHDs) such as: ● Septal defects (holes in the heart walls) ● Outflow tract anomalies (malformations of the major vessels) These defects can have lifelong implications for the child's health and may require surgical correction or long-term cardiac care. The Role of Nutrition in Maternal and Fetal Development Maternal nutrition is one of the most critical factors influencing the health of both the mother and the developing fetus. Around the time of organogenesis—when vital organs like the heart, brain, spine, and kidneys begin forming—the need for adequate nutritional reserves becomes especially urgent. Nutritional Needs During Organogenesis Organogenesis typically occurs during the first trimester, a period during which many women may not yet realize they are pregnant. Key nutrients required during this time include: ● Iron – Essential for oxygen transport and cellular energy production ● Folic Acid (Vitamin B9) – Prevents neural tube defects and supports red blood cell production ● Vitamin B12 – Works with folic acid in red blood cell formation and neurological development ● Inadequate levels of these nutrients, particularly iron, can reduce the mother's oxygen-carrying capacity, leading to fetal hypoxia (low oxygen delivery to tissues). This increases the risk of developmental abnormalities, especially congenital heart defects. Causes of Anemia Beyond Diet ● While poor dietary intake is a common cause of anemia, there are several non-dietary causes that must also be addressed: ● Hemoglobinopathies such as: o Thalassemia o Sickle Cell Anemia ● These are inherited blood disorders where the structure or production of hemoglobin is abnormal, leading to chronic anemia. Women with known or suspected hemoglobin disorders should be referred to a hematologist early in pregnancy (or ideally, before conception) to ensure appropriate monitoring and management. The Fetal Dependence on Maternal Stores The developing fetus is entirely dependent on the mother's nutritional status, especially for: ● Iron – for building fetal blood supply and heart tissue ● Folic Acid – for neural development ● Vitamin B12 – for brain and nerve development If the mother's nutrient levels are low, the fetus may be at risk for: ● Low birth weight ● Preterm birth ● Congenital anomalies ● Long-term developmental delays Preventing Anemia in Pregnancy: The Power of Nutrition and Prenatal Care A nutritious, well-balanced diet during pregnancy is one of the most effective ways to prevent anemia and support both maternal and fetal health. Nutritional needs increase during this time, and iron becomes essential for building extra red blood cells to carry oxygen to the baby. Iron-Rich Foods to Include in Your Diet To reduce the risk of anemia, ensure your meals include iron-rich foods, such as: ● Green leafy vegetables (spinach, fenugreek,) ● Legumes and beans ● Fruits (especially dried fruits like dates, raisins, apricots) ● Meat and liver (excellent sources of heme iron) ● Fortified cereals and whole grains ● Milk (though not rich in iron, it's a valuable part of a balanced diet) Don't Forget Vitamin C ● Vitamin C is crucial for enhancing iron absorption from plant-based foods. Include: ● Citrus fruits (oranges, lemons) ● Tomatoes ● Bell peppers ● Berries and guavas Prenatal Vitamins Are Essential In addition to food, prenatal vitamins prescribed by your healthcare provider supply important nutrients like: ● Iron ● Folic acid ● Vitamin B12 These supplements help build up maternal stores and support the baby's development, especially when dietary intake is not enough. Antenatal Check-Ups: Early Detection Saves Lives Regular antenatal (prenatal) check-ups are critical. Your doctor can: ● Monitor your hemoglobin levels ● Identify signs and symptoms of anemia early ● Order tests if needed (e.g., iron studies, screening for thalassemia or sickle cell disease) ● Recommend appropriate dietary adjustments, iron supplements, or specialist referral Conclusion Anemia during pregnancy should not be seen as a minor nutritional issue. It is a systemic condition with far-reaching consequences and preventing anemia is a shared responsibility—of the mother, the healthcare provider, and the health system. A proactive approach that combines nutritional care, supplementation, and regular medical check-ups ensures better outcomes for both mother and baby. (Dr. Sunitha Mahesh, Medical Director and Senior Consultant - Infertility and Maternal Fetal Medicine, Milann- The Fertility and Birthing Hospital, Bengaluru)
