Discuss the major challenges related to women’s reproductive health in India. What measures would you suggest to overcome these challenges? (2024, 20 Marks)
Maternal mortality has fallen to 93 per 100,000 live births (Sample Registration System, 2019–21) and institutional delivery to 90.6% (NFHS-6, 2023–24). Yet reproductive health as the International Conference on Population and Development (Cairo, 1994) defined it — complete physical, mental and social wellbeing in all matters of the reproductive system — remains unrealised, because its determinants are social rather than clinical.
The method mix and the coercive residue
- Contraception in India is almost wholly a female burden: female sterilisation is about 38% of the method mix against male sterilisation at 0.3% (NFHS-5). Prevalence has risen to 69.1% and unmet need fallen to 8.5% (NFHS-6), but the basket remains narrow and terminal.
- This is the afterlife of the Emergency (1975–77) sterilisation drive, which destroyed the acceptability of vasectomy and transferred the burden permanently onto women. The camp model industrialised that transfer: thirteen women died after a tubectomy camp at Bilaspur, Chhattisgarh, in November 2014. In Devika Biswas v Union of India (2016) the Supreme Court ordered sterilisation camps phased out, struck at the target-based approach, required counselled informed consent, and held reproductive rights to be part of Article 21.
Nutrition, early marriage and the life-cycle
- Anaemia affects 57% of women aged 15–49 (NFHS-5) — the one major indicator that moved backwards between rounds.
- Meanwhile overweight and obesity among women rose from 24.0% to 30.7% between NFHS-5 and NFHS-6: a double burden, with gestational diabetes and hypertensive disorders rising alongside anaemia.
- 20.1% of women aged 20–24 were married before 18 (NFHS-6, down from 23.3%), and adolescent childbearing compresses the reproductive span into the years of highest obstetric risk.
The autonomy deficit and the neglected agenda
- The decisive variable is who decides. Amartya Sen’s capability and agency argument, and Tim Dyson and Mick Moore’s north–south thesis (1983), locate reproductive outcomes in female autonomy — kinship, post-marital residence, property and schooling — not in clinic density.
- Unsafe abortion still causes roughly 8–10% of maternal deaths; the MTP Act, 1971 (amended 2021) protects the registered medical practitioner rather than entitling the woman, so abortion remains a permission.
- Whole domains go unattended: menstrual health (78% of women 15–24 use a hygienic method, only 73% in rural India, NFHS-5), infertility and its stigma, post-partum depression at roughly 22% of mothers — with the birth of a daughter a documented risk factor — and cervical cancer, of which India carries about a fifth of the world’s cases.
Measures
- Rebalance the method mix. Replace camps with fixed-day static services at functioning facilities; make spacing methods, injectables and non-hormonal options genuinely available; and rebuild male responsibility through counselling addressed to husbands rather than to women alone.
- Enforce the Devika Biswas directions. No targets, no camps, independent audit of consent, prompt compensation, reproductive-rights training for frontline workers.
- Treat abortion as an entitlement. Certify more providers, take medical abortion to primary-level facilities, simplify the second-trimester board requirement, and protect confidentiality for unmarried women as X v Principal Secretary, Health, NCT of Delhi (2022) requires.
- Attack the social determinants. Retaining girls in secondary school and raising age at marriage will do more than any new clinic; anaemia needs dietary diversification and fortification, not tablets alone.
- Widen the definition in practice. Screen for perinatal mental health within antenatal care, bring menstrual health and infertility services into the package, and carry the nationwide HPV vaccination of 14-year-old girls begun in February 2026 into rural districts.
Conclusion
Feminist scholars such as Imrana Qadeer and Mary E. John argue that Indian policy long made women’s bodies the instrument of demographic ambition. The reform required inverts that logic: make women’s autonomy and wellbeing the measure of success, and demographic outcomes will follow, as Kerala and Tamil Nadu have shown.