Born into the Gap: India’s Parenthood Crisis Uncovered
On the occasion of World Population Day, The Pioneer brings you an in-depth report on India’s parenthood paradox — where rising numbers mask deeper systemic gaps in reproductive awareness, access, and equity. From cultural silence and inadequate counselling to delayed fertility and mental health challenges, leading experts weigh in on why family planning needs to be reimagined not just as a medical concern, but as a fundamental human right and social priority
Highlighted quote: Most of the women fail to seek preconception counselling when they are planning pregnancy. Silence around reproductive choices is considered both cultural and systematic. In the urban slums women only visit the gynaecologist when they have already landed up with complications and almost never with a proper planning. There is also a need to normalise the reproductive check-ups and integrate them with the health initiatives of school and community
Tejal Sinha
As India steps into the demographic era and it is also the world’s most populous country with the population of around 1.44 billion citizens due to which the conversation regarding reproductive health has now become more significant. As India celebrates its growing economy, health care experts on the same time warn regarding the huge gap in reproductive health awareness, access, and equity.
Behind this huge rise in population there is a complex interplay of cultural silence, limited contraceptive access, inadequate sexual education, and persistent gender inequality. Since the policies exist on the paper their implementation still remains a very crucial factor. Reproductive health particularly in women is very often reduced to contraception or pregnancy which ignores the broad spectrums of mental health, uninformed choices and maternal safety as well.
To get a better understanding of these issues, insights from the experts in obstetrics and gynaecology always provide valuable knowledge related to reproductive health in India.
According to Dr. Nivedita Jha, Consultant – Obstetrics and Gynaecology, SPARSH Hospital, Infantry Road, Bangalore said, “Most of the women fail to seek preconception counselling when they are planning pregnancy. Silence around reproductive choices is considered both cultural and systematic. In the urban slums women only visit the gynaecologist when they have already landed up with complications and almost never with a proper planning. There is also a need to normalise the reproductive check-ups and integrate them with the health initiatives of school and community.”
“Urban reproductive health kiosks should also be set up which provides the women accessibility to both services and information without any stigma,” said Dr. Nivedita.
Research conducted by the Indian Council of Medical Research in 2023 has surveyed around 1,500 women across Mumbai slums. The study also found that 18% of them do not use any form of contraception before their first pregnancy and 12% of them do not receive any counselling on the family planning.
As per Dr. Karnika Tiwari, Head of Department, Obstetrics and Gynaecology, Motherland Hospital, Noida said, “Women from rural areas only come to us when things go out of control. There is also a lack of preventive mindset among them when it comes to the concern of reproductive health. Reproductive health is not just the problem of women. Under the national health mission target campaigns should be carried out which should involve both men and women. The conversation regarding reproductive health will remain one sided and ineffective unless the men become the active participants”.
As per the research of PGIMER’s Community Medicine Department (2022), 68% of women did not have knowledge related to the long-acting reversible contraceptives (LARCs) and 55% of women said that the final decision regarding their family size is made by their husbands.
According to Dr. Renu Gupta, Director, Obstetrics and Gynaecology, Sri Balaji Action Medical Institute Delhi said, “The concept of choice is better aligned with the young girls – they are not asked when they want to get married or when they want children. Reproductive literacy modules in the region of Madras and local schools alongside mother-daughter reproductive health clubs should be established. We also need to create safe and culturally sensitive spaces in our society where women are able to learn, speak and ask without feeling shame.”
Another study from United Nation Population Fund India in Aligarh and nearby districts shows that early marriage and lack of menstrual education significantly contribute to repeated pregnancies and poor maternal health. 4o% of women that are aged between 18–25 already had more than two pregnancies.
As per Dr. Nikhat Siddiqui, Consultant Obstetrics and Gynecology, Apollo Spectra Hospital, Kanpur said, “More focus is made on physical health, but things which are often ignored are high fertility, miscarriages and unplanned pregnancies damage the psychological well being of individuals. Interdisciplinary reproductive care, combining gynaecology, psychiatry, and social work are some of the factors which should get the desired attention”.
“Every woman should be provided with comprehensive reproductive counselling not just on the physical basis but on the emotional basis too. Parenthood is not a chore it is a choice and every choice should originate from the informed, supported space,” said Dr Nikhat
A longitudinal study of over 500 women found that 26% of women suffering from postpartum depression undergo unplanned or unwanted pregnancies and 18% of women suffer from the problem of untreated reproductive trauma from past terminations or stillbirths.
India’s population is growing on a fast phase but most importantly it is aging and still they yield new mothers. Choices regarding reproduction also cause an effect on the quality of generational health and women’s lifelong well-being. Without any proper planning women in their pregnancy phase suffer with anaemia, diabetes, hypertension, and under- or overnutrition. 30-40% of pregnancy related complications can be avoided with the help of early counselling, contraception and screening methods.
Dr. Anupama Gangwal, Senior Consultant Obstetrics and Gynaecology, Cocoon Hospital, Jaipur explains, India is now the world’s most populous country, with around 51 babies born every minute. But World Population Day reminds us that these numbers tell only part of the story. The good news is that the population growth rate has dropped sharply—from nearly 3% to about 1.5%—reflecting positive shifts in education, healthcare access, and social awareness.
Behind these figures lie complex realities that demand urgent attention. Rising education levels and career ambitions are leading to delayed pregnancies, which bring age-related fertility concerns into focus. Additionally, factors like stress, sedentary lifestyles, pollution, and poor diets are contributing to a growing infertility problem affecting both men and women, especially in urban areas.
Rajasthan faces its own unique challenges. Although the state has made significant strides in lowering fertility rates, with a current Total Fertility Rate (TFR) of 2.0, rural areas still struggle with limited access to reproductive healthcare. Early marriages remain common, and the declining sex ratio—928 females per 1,000 males, below the national average—raises serious concerns.
As healthcare professionals, we know that population health isn’t just about statistics. It’s about ensuring every woman receives respectful maternity care, every couple has access to family planning, and every child is born into a healthy environment.
This World Population Day, let’s encourage open conversations about family planning, promote accessible contraception, and work together to build a healthier, more equitable Rajasthan for generations to come.
Dr Manini Patel, Senior Consultant – Obstetrics & Gynaecology, Apollo Spectra Hospital, Jaipur further said that experts believe that the health of population is not about the numbers it is also about ensuring that every woman is provided with the dignified maternity care, every couple have access to family planning and every child is born in the healthy environment.
The time has come to broaden the narrative because the health of the population is not only a numbers game, in fact it is a people’s movement. We can only say that we are prepared for the future when women in our country have the freedom to make their right choose, sufficient knowledge to make their decisions and adequate support from the society’s people as well. Some ongoing initiatives by the government of India such as running a “Fertility Literacy Before 30” awareness campaign across the colleges of the country, collaborating with the startups for building AI- driven fertility forecasting models for Indian women should also be carried out on long term basis.
As India faces a complex challenge of growing population, leading healthcare institutions like Cocoon, Motherland, and Apollo Spectra are setting a great example by adopting the latest technological advancements on a regular basis and delivering patient-centric care. All these proactive efforts not only reduce these critical gaps but also reinforces the nation’s collective commitment to building a healthier, more equitable future for all.
