Family planning: The future is in gender justice

India’s patriarchal norms have shaped a contraceptive pattern that disproportionately places the burden on women

In June 2025, the United Nations Population Fund (UNFPA) released a comprehensive report reframing global demographic concerns by shifting the narrative from population control to reproductive autonomy. The report emphasised that demographic debates must now prioritise individuals’ access to reproductive health services, bodily autonomy, and informed choice, particularly in countries like India, where fertility patterns reveal stark regional contrasts.

Northern states such as Bihar, Jharkhand, and Uttar Pradesh continue to register fertility rates above replacement level, reflecting persistent disparities in access to healthcare, quality education, and entrenched patriarchal norms.

Meanwhile, urbanised and southern states such as Delhi, Kerala, and Tamil Nadu have sustained fertility rates below replacement levels for several years, raising concerns about future labour shortages and ageing populations.

This dual demographic reality has begun to influence state-level policy decisions. In November 2024, the Government of Andhra Pradesh repealed a three-decade-old law that barred individuals with more than two children from contesting urban local body elections.

Originally enacted to discourage high fertility, the law was rendered obsolete by the state’s current Total Fertility Rate (TFR) of 1.6, significantly below the national average of 2.1. The legislative amendment aims to arrest further demographic decline and recalibrate the population policy in line with emerging socio-economic needs.

This development reflects a broader national trend: while some states are still grappling with high fertility, others are confronting the economic and social implications of declining birth rates.

To contextualise India’s current demographic crossroads, we must revisit the foundational trajectory of its population policies. 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 generations.

Between 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 complications.

While 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 framework.

Despite 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 1970s.

This imbalance reflects a broader societal failure to promote equitable reproductive responsibility and to prioritise the safer and more sustainable options.

Around 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 elusive

Between 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 outcomes.

India, 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 skewed.

Many 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 norms.

As 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 engagement.

The 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)