Contraception beyond access: barriers in uptake, perceived health risk and choice gaps in India

Neha Chhawal; Veena; Kanika  Arora; Jitendra Kumar Meena

doi:10.18203/2394-6040.ijcmph20264135

Authors

Neha Chhawal Department of Biochemistry, AIIMS New Delhi, India
Veena Department of Biochemistry, AIIMS New Delhi, India
Kanika Arora Department of Obstretrics and Gynaecology, Government Medical College, Sawai Madhopur, Rajasthan, India
Jitendra Kumar Meena Department of Preventive Oncology, National Cancer Institute, AIIMS, Jhajjar, Haryana, India

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20264135

Keywords:

Contraception, India, Barriers, Birth control

Abstract

India has a long-standing family planning programme, yet contraceptive use remains characterised by reliance on female sterilisation, limited uptake of reversible methods, and high discontinuation of temporary contraception. Despite improvements in overall prevalence, access alone has not translated into sustained or equitable use. This narrative review synthesises epidemiological, qualitative, and policy-oriented evidence to examine how contraception-seeking behaviour in India is shaped by social norms, gendered decision-making, health-system practices, and perceptions of health risk, with particular attention to cancer-related fears. The literature indicates that contraceptive decisions are rarely individual choices, being embedded within marital expectations, fertility pressures, and constrained female autonomy. Fear of side effects, especially concerns about long-term health and cancer, deters uptake and continuation of hormonal methods despite evidence of limited, time-bound risks and substantial protection against ovarian and endometrial cancers. These concerns are reinforced by inconsistent counselling and provider bias, highlighting the need for behaviour-centred, rights-based family planning.

References

Ministry of Health and Family Welfare, Government of India. Chapter 9: Family Welfare Programme. New Delhi: Ministry of Health and Family Welfare; 2019. Available at: https://mohfw.gov.in/sites/ default/files/06%20Chapter%2093AN2018-19.pdf. Accessed on 15 August 2026.

New JR, Cahill N, Stover J, Gupta YP, Alkema L. Levels and trends in contraceptive prevalence, unmet need, and demand for family planning for 29 states and union territories in India: a modelling study using the Family Planning Estimation Tool. Lancet Glob Health. 2017;5(3):e350-8.

International Institute for Population Sciences. National Family Health Survey (NFHS-4). 2017. Available at: https://dhsprogram.com/pubs/pdf/ FR339/FR339.pdf. Accessed on 24 August 2026.

International Institute for Population Sciences. National Family Health Survey (NFHS-5). 2022. Available at: https://dhsprogram.com/pubs/pdf/ FR375 /FR375.pdf. Accessed on 24 August 2026.

Ghule M, Raj A, Palaye P, Dasgupta A, Nair S, Saggurti N, et al. Barriers to use contraceptive methods among rural young married couples in Maharashtra, India: Qualitative findings. Asian J Res Soc Sci Humanit. 2015;5(6):18-33.

Parsekar SS, Hoogar P, Dhyani VS, Yadav UN. The voice of Indian women on family planning: a qualitative systematic review. Clin Epidemiol Glob Health. 2021;12:100906.

Mukherjee S, Mahapatra B, Saggurti N. Why women do not use contraceptives: exploring the role of male out-migration. PLoS One. 2021;16(3):e0249177.

Nanda S, Ojha R, Nayak S. Barriers to contraceptive use in adult women attending a tertiary referral hospital. Int J Adv Res Med. 2020;2(1):46-9.

Mishra N, Panda M, Pyne S, Srinivas N, Pati S, Pati S. Barriers and enablers to adoption of intrauterine device as a contraceptive method: a multi-stakeholder perspective. J Family Med Prim Care. 2017;6(3):616-21.

Barman K, Roy M, Choudhary SS, Naznin W. Knowledge, attitude and practices of contraception among the married women of reproductive age. N Indian J OBGYN. 2021;7(2):224-7.

Hannaford PC, Selvaraj S, Elliott AM, Angus V, Iversen L, Lee AJ. Cancer risk among users of oral contraceptives: cohort data from the Royal College of General Practitioners' oral contraception study. BMJ. 2007;335(7621):651.

Cibula D, Gompel A, Mueck AO, La Vecchia C, Hannaford PC, Skouby SO, et al. Hormonal contraception and risk of cancer. Hum Reprod Update. 2010;16(6):631-50.

International Agency for Research on Cancer. Combined estrogen-progestogen contraceptives and combined estrogen-progestogen menopausal therapy. IARC Monogr Eval Carcinog Risks Hum. 2007;91:1-528.

Shekhar C, Sahoo H, Das L. Usage of contraception among the married women in India, 2019–21: a cross-sectional study. Contracept Reprod Med. 2025;10(1):60.

Dixit A, Johns NE, Ghule M, Battala M, Begum S, Yore J, et al. Male-female concordance in reported involvement of women in contraceptive decision-making and its association with modern contraceptive use among couples in rural Maharashtra, India. Reprod Health. 2021;18(1):139.

Vishwakarma M, Shekhar C. Covert use of reversible contraceptive methods and its association with husband's egalitarian gender attitude in India. BMC Public Health. 2022;22(1):460.

Mishra A, Nanda P, Speizer IS, Calhoun LM, Zimmerman A, Bhardwaj R. Men's attitudes on gender equality and their contraceptive use in Uttar Pradesh, India. Reprod Health. 2014;11(1):41.

Kaur J, Singh R, Singh P. "I did not know what they are": understanding support needs of women around family planning in rural India. Proc ACM Hum Comput Interact. 2025;9(CSCW2):1-24.

Shukla A, Kumar A, Mozumdar A, Acharya R, Aruldas K, Saggurti N. Restrictions on contraceptive services for unmarried youth: a qualitative study of providers' beliefs and attitudes in India. Sex Reprod Health Matters. 2022;30(1):2141965.

Mehta NR, Darak SS, Parchure RS. The use of emergency contraceptive pills in India: a meta-analysis. Indian J Public Health. 2020;64(2):178-85.

Agrawal R, Mishra M, Rehman T, Surendran G, Sinha A, Kanungo S, et al. Utilization of modern temporary contraceptive methods and its predictors among reproductive-aged women in India: insights from NFHS-5 (2019-21). Front Glob Womens Health. 2023;4:1219003.

Khan ME, Bhatnagar I. Challenges in introducing new contraceptive methods: a case study of India. Int Q Community Health Educ. 2015;35(4):387-401.

Karmakar A, Pal J, Saha R, Satapathy S, Ghosh M. Exploring experiences regarding contraception practices among married men in a rural area of West Bengal: a qualitative study. Asian Pac J Reprod. 2025;14(2):56-61.

Ministry of Health and Family Welfare, Government of India. India’s Vision FP2030. 2022. Available at: https://nhm.gov.in/images/pdf/programmes/family-planing/guidelines/FP2030_Vision-Document.pdf. Accessed on 24 August 2026.

Ministry of Health and Family Welfare, Government of India. Annual Report: Family Planning 2020–21. 2021. Available at: https://nhm.gov.in/New_Updates _2018/NHM_Components/RMNCH_MH_Guidelines/family_planning/IEC_Material/Annual_report/Annual_report_20-21.pdf. Accessed on 24 August 2026.

Hellwig F, Moreira LR, Silveira MF, Vieira CS, Rios-Quituizaca PB, Masabanda M, et al. Policies for expanding family planning coverage: lessons from five successful countries. Front Public Health. 2024;12:1339725.