For many women and teenage girls, menstruation is not simply a set of dates circled on a calendar, the way birthdays and anniversaries are. It carries its own weight in the form of fatigue, cramps, headaches, body aches and for many, a genuine inability to function normally. Yet the expectation of normalcy persists regardless. Classes must be attended, meals must be cooked, workplace obligations must be met, and domestic duties remain, as ever, the icing on the cake. Rest, in this equation, is treated as a luxury rather than a basic physiological need. And this is precisely the dimension most often missing from conversations about Jammu & Kashmir’s declining fertility rate.

The Total Fertility Rate of the Union Territory has slipped to 1.4 children per woman. This is well below the replacement threshold of 2.1 required merely to keep the population stable. The reasons cited are familiar: rising unemployment, economic uncertainty, delayed marriages, wider access to contraception and the escalating cost of raising a child. Each of these is undeniably significant. But is there a cost we are failing to reckon with — one that goes unspoken precisely because it is inscribed on women’s bodies? The physical toll of childbirth itself.

Menstrual health is usually discussed only through the narrow lens of hygiene like sanitary pads, cleanliness, discretion, yet it is, in fact, the very bedrock of a woman’s fertility. Dysmenorrhea, for instance, is a condition marked by such painful menstruation that it disrupts a woman’s ability to carry out everyday activities. Polycystic Ovarian Syndrome and endometriosis are two further conditions capable of compromising both menstrual health and reproductive capacity. Menstrual health, then, is not a peripheral concern but a foundational one. It is recognised by global health bodies as inseparable from a woman’s complete physical, mental, and social well-being.

To be clear, the absence of rest during menstruation does not, by itself, cause infertility. This claim would be a reductive one. What matters instead is the cumulative consequence of routinely........

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