[Answered] UNFPA highlights India’s ‘fertility crisis’ as denial of reproductive agency, not just declining numbers. Analyze how public health policies and social justice initiatives must be reoriented to ensure genuine reproductive choice and empowerment.

Introduction

The UNFPA’s State of the World Population Report 2025 reframes the “fertility crisis” as a denial of reproductive agency rather than mere demographic decline. In India, this calls for a re-evaluation of public health and social justice frameworks, ensuring reproductive choices are rights-based, equitable, and aligned with individual aspirations—not driven by population control imperatives.

Reproductive Agency: The Real Crisis

1. Shifting Narrative: India’s Total Fertility Rate (TFR) has fallen to 2.0 (SRS 2020), below the replacement level of 2.1. However, the focus must shift from numbers to reproductive justice — ensuring individuals can decide if, when, and how many children to have.
2. Unmet Aspirations: According to UNFPA and YouGov, 36% of Indians faced unintended pregnancies, and 30% couldn’t conceive when they wanted to. NFHS-5 data reveals a 9.4% unmet need for family planning among married women aged 15–49.
3. Underachieved and Overachieved Fertility: Both having more children than desired and being unable to have children when desired reflect constraints in accessing contraception, assisted reproductive technologies (ART), and support systems.

Reorienting Public Health Policies

1. Diversify Family Planning Options: India’s contraception regime is still skewed towards female sterilization (over 37% usage in NFHS-5). Need to promote reversible methods—condoms, IUDs, injectables, and emergency contraceptives—with awareness campaigns, particularly among youth and rural populations.
2. Integrated Reproductive Healthcare: Link family planning to maternal health, infertility treatment, and reproductive counseling. Make ARTs affordable and regulated; infertility remains stigmatized and treatments are costly due to private-sector dominance and lack of insurance coverage.
3. Access for Marginalized Communities: Scheduled Castes, Scheduled Tribes, and women in the informal sector face compounded barriers due to poor infrastructure, social stigma, and limited awareness.

Social Justice and Structural Reforms

1. Gender-Responsive Reproductive Ecosystem: Strengthen laws and policies around parental leave, workplace childcare, flexible work, and non-discriminatory hiring. Only 10% of Indian workers have access to maternity benefits (ILO, 2023).
2. Address Social Norms and Male Involvement: Encourage male responsibility in family planning and caregiving. Break stigma around discussing contraception, infertility, and reproductive rights, especially in conservative communities.
3. Education and Empowerment: Comprehensive sexuality education in schools, vocational training, and community outreach are crucial. Empowering girls through education is key to informed reproductive choices. As per NFHS-5, early marriage still affects 23.3% of women aged 20–24.

Conclusion

India’s fertility challenge is not numeric but normative—rooted in restricted agency and unequal power structures. Policies must pivot from controlling fertility to empowering choice. A people-centred, gender-just approach to reproductive health, anchored in dignity and equity, is essential for a resilient and responsive population strategy in a transforming demographic landscape.