5 days ago
Choice, confidence, and care: Strengthening modern contraceptive access in India
In my consulting room, patients come seeking contraceptive counselling. The questions are in a hushed tone, patients ask: 'Will this affect my fertility later?' 'Is it safe?' 'Will anyone else find out?'. These queries come from women across age groups, professions, and backgrounds. Whether a college student or a homemaker, a shared thread often emerges--hesitation. This is not because they lack awareness, but because they are unsure about safety, stigma, control, and the range of options available to them.
India has made significant progress in expanding access to contraception. Government programs like Mission Parivar Vikas and the rollout of health and wellness centres under Ayushman Bharat have strengthened service delivery in high-focus states. As a result, the modern contraceptive prevalence rate has steadily increased.
Yet, some gaps remain. One common issue is the limited range of choices presented to women, especially when it comes to long-acting reversible methods (LARCs). In many cases, decisions around contraception are made quickly and with limited counselling, particularly after childbirth. Instead of being offered the expanded basket of choices, women are steered toward permanent methods like female sterilisation without adequate time or space to consider other options.
In urban private practice, on the other hand, the challenge is not availability, but approachability. A younger patient may have heard of newer methods like DMPA-SC injectables or subdermal implants, but still feel unsure or embarrassed to ask about them. The gap between knowing a method exists and feeling confident enough to choose it is real, and it's here that both the public and private systems must do better.
As a professional body, the Federation of Obstetric and Gynaecological Societies of India (FOGSI) sees this as a shared responsibility. We are actively working to sensitise our members across India on method counselling, especially for newly introduced, but highly effective, options that offer women greater flexibility and agency.
Injectables and subdermal implants are especially promising. They reduce the need for frequent follow-ups, offer privacy, and are reversible. However, to successfully introduce them at scale, we need a robust ecosystem like trained providers, consistent supply chains, and supportive counseling environments where women feel heard and respected.
Equally important is making conversations around contraception feel more natural and less clinical. We must embed family planning discussions into routine health care moments, whether during antenatal visits, adolescent health check-ups, or postnatal counselling. These moments offer valuable opportunities to provide information when women are already engaged with the health system.
Destigmatising contraception also means widening the circle of who is part of the conversation. Too often, women are counselled alone, while decisions within families may involve spouses or in-laws. If men are excluded from the discussion, they may also lack accurate information or even oppose contraceptive use. We need more male-inclusive approaches, including workplace health initiatives, community outreach by male health workers, and relatable content via digital media can all help shift attitudes.
As practitioners, we must remember that access does not automatically mean empowerment. A wider basket of contraceptive choices means little if a woman doesn't feel safe or supported in making her own decision. While apps, teleconsults, and anonymous chatbots have made information more accessible, nothing can replace the value of a non-judgmental, face-to-face conversation with a trusted provider.
Our ultimate goal must be to ensure that family planning is seen not as a taboo or a hush-hush conversation, but as a core part of everyday well-being. When a woman walks into a clinic, public or private, she should be asked what she wants, not told what she should use. That shift, rooted in choice, confidence, and care, can transform lives. That is the India we must strive to build.
This article is authored by Dr Sunita Tandulwadkar, president, Federation of Obstetric and Gynaecological Societies of India (FOGSI).
