Choices for a nation with falling fertility

India is on a fertility decline. With 31 out of 36 states and Union territories achieving replacement-level fertility or even below this threshold, we are transitioning into a new demographic era. India is home to the world’s largest youth population — 65% of our citizens are under the age of 35. This demographic advantage presents an opportunity for a more productive and an economically stronger future for the nation. It is, therefore, important that we accelerate our investments in our human capital. A critical factor for India to achieve development goals is to ensure widespread access to reproductive health services, including modern contraceptives.
We are at a moment in time when modern contraception, which improves and saves lives, must also be seen as an instrument of agency, autonomy, and socio-economic empowerment. The benefits have disproportionately greater impact on the lives of women. It is imperative then to recognise the potential we will unlock when we invest in women’s (and their partners’) access to modern contraceptives and family planning services.
The data could not be clearer: Greater access to modern contraceptives could increase women’s participation in the workforce, which could add up to $770 billion to India’s GDP by 2025. Unplanned pregnancies can potentially disturb a woman’s educational or professional ambitions, pushing her out of the workforce and into caregiving roles that restrict her potential to contribute to a family’s financial security. When individuals and couples can plan their families, they can also pursue their dreams — be it higher education, or career advancement.
Modern contraceptives are more than just “family planning” tools — they are life-saving health interventions. Using modern contraceptives like oral pills, condoms, intrauterine devices (IUDs), and other methods reduces the incidence of unintended pregnancies and closely spaced births. Unplanned and closely spaced childbirth is linked to poorer health outcomes for women and their babies, including being correlated with maternal mortality, and premature births, that bring a host of risks for the newborn.
The Indian government, through its family planning division, launched Mission Parivaar Vikas in 2016, which has resulted in a significant improvement in the uptake of contraceptives. Through the years, newer, reversible methods like subdermal implants and injectables such as Antara-SC have been introduced, providing individuals with greater flexibility and safer, long-term choices, reflecting the government’s commitment to enhancing reproductive health and autonomy.
Yet, despite these advancements, the responsibility of contraception has remained disproportionately on women. Although contraception utilisation rates have increased, and the basket of choices of reversible methods has expanded, nearly 38% of married Indian women still opt for permanent sterilisation, making it the predominant method. This reality reflects the limited awareness of newer methods and the persistence of patriarchal norms. Pregnancy and family planning are burdens carried by women alone. This imbalance must be corrected.
We need to embrace innovative solutions. Digital tools like mobile apps and chatbot counselling provide discreet, convenient ways for couples to access information on contraception. These tools can offer tailored advice, address common concerns, and help bridge the knowledge gap, particularly in underserved areas.
The rise of male contraceptive options will be a crucial step. The reversible, non-hormonal injectable RISUG (Reversible Inhibition of Sperm Under Guidance), developed by the Indian Council of Medical Research, represents a leap in male contraception. Safe, effective, and reversible RISUG opens the door to a future where men actively participate in family planning and share the responsibility.
Shamika Ravi is member, Economic Advisory Council to the Prime Minister; and Jaydeep Tank is president, Federation of Obstetric and Gynaecological Societies of India.The views expressed are personal