Financial issues among top barriers to reproductive freedom in India: UN report
Instead, it points to a more nuanced and pressing issue: millions of individuals globally, including in India, are unable to realise their desired fertility outcomes due to a complex web of structural, social, and economic barriers.This is the real crisis, not underpopulation or overpopulation.FERTILITY RATES HIDE INEQUALITYIndia, the report notes, has achieved replacement-level fertility, defined as 2.1 births per woman, with the national figure now standing at 2.0.This achievement has been credited to advances in education, improved access to reproductive healthcare, and a robust family planning framework.'India has made significant progress in lowering fertility rates, from nearly five children per woman in 1970 to about two today, thanks to improved education and access to reproductive healthcare. This has led to major reductions in maternal mortality, meaning a million more mothers are alive today, raising children and building communities," said Andrea M. Wojnar, UNFPA India Representative.advertisementWhile India may have reached replacement-level fertility of 2.0, many people, especially women, still face barriers to making free and informed decisions about their reproductive lives.The report also highlights gaps across regions and states.These barriers create what the report identifies as India's 'high fertility and low fertility duality.'States such as Bihar, Jharkhand, and Uttar Pradesh continue to report higher fertility rates, while southern and urbanised regions like Kerala, Tamil Nadu, and Delhi have sustained below-replacement levels.This duality, the UN researchers say, reflects enduring disparities in economic development, access to quality healthcare and education, and the persistence of patriarchal social norms.According to the survey findings, one of the biggest barriers to reproductive freedom is financial insecurity.Nearly 40% of respondents said they are unable to have the number of children they desire due to economic limitations.Other cited factors include:Housing constraints (22%)Job insecurity (21%)Lack of affordable childcare (18%)Poor general health (15%)Infertility (13%)Limited access to pregnancy-related care (14%)Besides this, emotional and societal pressures are shaping reproductive decisions.About 19% of the respondents said they experienced partner or family pressure to have fewer children than they personally wanted.Rising concerns over climate change, political instability, and an increasingly uncertain future were also reported as deterrents to childbearing.advertisementThe report highlights that modern fertility decisions are not merely medical or biological choices, they are shaped by the complex realities of contemporary life."The real demographic dividend comes when everyone has the freedom and means to make informed reproductive choices. India has a unique opportunity to show how reproductive rights and economic prosperity can advance together," Wojnar stated.NEW CHALLENGESBeyond traditional barriers, the report draws attention to emerging social realities such as the rise in loneliness, shifting relationship dynamics, and the difficulty many face in finding supportive partners.The social stigma around reproductive choices, especially among unmarried individuals, LGBTQIA+ persons, and those choosing non-traditional family paths, continues to hinder reproductive freedom.One concern is the rising expectation of "intensive parenting", a phenomenon placing disproportionate pressure on women and reinforcing unequal caregiving roles and influencing decisions about if and when to have children.These expectations, the report argues, not only discourage parenthood but also limit the personal and professional agency of women.In response to these challenges, the UNFPA has proposed a five-pronged framework to guide India toward demographic resilience,advertisementUniversal access to sexual and reproductive health services: Including contraception, safe abortion, maternal healthcare, and infertility treatment.Removing structural barriers: Through investments in childcare, education, housing, and workplace flexibility.Promoting inclusivity: By extending healthcare and reproductive services to unmarried individuals, LGBTQIA+ communities, and marginalised populations.Enhancing data and accountability: Going beyond fertility statistics to track unmet needs and bodily autonomy.Driving social transformation: Via community-led campaigns that challenge stigma and improve reproductive health literacy.'The real fertility crisis is not how many children people are having, but that so many are unable to have the children they want, if and when they want them," the report concludes.
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The National Programme for Family Planning, launched in 1952, was the first state-led population control programme in the world, introduced to stabilise population growth and improve reproductive health. In its early years, the programme relied heavily on male sterilisation (vasectomy) as a central strategy. However, the momentum shifted dramatically following the Emergency period of the mid-1970s, during which millions of men were estimated to have been subjected to forced sterilisations under coercive state-led campaigns. The socio-political backlash from this period was profound and enduring, embedding a deep mistrust of vasectomy that persists across 1966 and 1970, vasectomies accounted for 80.5% of all sterilisations performed in India. However, by 1981-85, this figure had fallen to 14.8%, and according to the latest National Family Health Survey (NFHS-5), vasectomy now comprises merely 0.3% of modern contraceptive use. Data from the Health Management Information System (HMIS) reveal that in 2019-20, only 55,324 male sterilisations were conducted nationwide, compared to over 34 lakh female sterilisations. The disparity is particularly significant given that vasectomy is a safer, simpler, more cost-effective, and more easily reversible procedure than female sterilisation (tubectomy), a more complex surgical intervention involving general or spinal anaesthesia, longer recovery periods, and a significantly higher risk of vasectomy can often be reversed successfully within a specific time frame, tubectomy is generally considered irreversible, placing a permanent burden of contraceptive responsibility on women. According to data released by the Brihanmumbai Municipal Corporation (BMC) in 2017, 33 women in Mumbai died after undergoing tubectomy procedures over ten years. Such outcomes highlight the urgent need to reassess the gendered division of sterilisation in India's public health these disparities, female sterilisation continues to dominate India's contraceptive landscape, driven not by clinical efficacy but by a convergence of patriarchal social norms, systemic neglect of male involvement, and the enduring historical trauma associated with male sterilisation campaigns during the imbalance reflects a broader societal failure to promote equitable reproductive responsibility and to prioritise the safer and more sustainable one-third of Indian men believe contraception is a woman's responsibility. NFHS-5 further shows that 20% of men suspect contraceptive use may make women promiscuous, amplifying stigma and reducing male accountability. These beliefs are intensified in child marriage settings, where women married young have limited autonomy and are often subject to controlling and even violent behaviour from their spouses. This power imbalance reinforces tubectomy as the default choice. Ironically, while socio-cultural resistance persists, the government offers greater financial incentives for vasectomy (Rs 1,500) than for tubectomy (Rs 1,000)..Informed choice is 2015-16 and 2019-21, modern contraceptive use by married women rose from 48% to 56%, with sterilisation leading the trend. Still, large unmet needs for contraception persist, especially in rural and marginalised communities where poor transport and inadequate facilities worsen maternal now the most populous country in the world, stands at a critical demographic juncture. This population scale offers both potential and peril. While the youth demographic is often hailed as a growth engine, it risks becoming a demographic burden if reproductive responsibilities remain unequally shouldered and access to informed, voluntary family planning continues to be Indian states have already recorded total fertility rates (TFR) below the replacement level of 2.1, signalling an impending shift towards a shrinking workforce and an ageing population. In the absence of strong social security systems, this trend could severely strain public resources. A contraceptive policy that disproportionately places the burden on women is not only unjust but economically myopic, undermining the long-term sustainability of health and welfare systems. Addressing these imbalances requires strengthening grassroots health systems. ASHA workers, as the backbone of India's reproductive health outreach, play a pivotal role in educating communities, countering misinformation, and promoting male participation in family planning. However, challenges such as inadequate training, overwhelming workloads, and delayed remuneration limit their effectiveness in shifting entrenched gender we observe World Population Day today, the imperative is clear: the focus must shift from population control to a rights-based, gender-equitable reproductive health framework. Policy measures must prioritise informed choice, shared responsibility, and regional parity, drawing from international models that have successfully promoted male involvement and community future of the world's largest population will not be determined by its size, but by how fairly and effectively its people are empowered to decide their reproductive lives..(Pavithra is a UG student and Maya is an assistant professor at the Department of Economics, CHRIST Deemed to be University, Bengaluru)
