India has been able to bring down its total fertility rate in recent years. But the not so good news is that there still exists a big gap between total fertility rate (TFR) or the average number of children a woman has and total wanted fertility rate (TWFR) or what the rate could be if all unwanted pregnancies could be averted and women could have the number of children they wanted. One in three women (36 per cent) in India experienced unwanted pregnancies, according to the 2025 United Nations Population Fund (UNFPA) and YouGov survey across 14 countries.
Bihar, among the top three high fertility states in the country, is a prime example where TFR has come down to 3, but TWFR is 2.2, indicating many of these births are unintended. In addition to poor access to health and contraceptive services, deeply entrenched patriarchal norms have exacerbated problems women face in planning families.
However, some districts have shown that these barriers can be overcome. About 14 million unwanted pregnancies were avoided over 10 years by training and motivating rural health workers to work with communities and advise them about family planning services by Janani, a Patna-based non-Governmental organisation working on family planning. One of the reasons why this strategy worked was its insistence on deploying couples only as FP motivators. By training the wife, it was able to get women to step out of their traditional roles and empower them to be change agents.
The success in addressing misconceptions about family planning by the husband-wife team was due to the well-defined roles and responsibilities of each partner. For instance, while the wife looked after the women, her husband was in charge of advising the men. Along with providing accurate information about intrauterine devices (IUDs) and oral pills, the couple offered advice to pregnant women about nutrition and child spacing. More importantly, they stressed the importance of the health of the woman. They explained that a woman should not be the one to bear the burden of family planning and feel compelled to undergo tubal ligation. They educated men about the option of no-scalpel vasectomy (NSV), which was quicker than tubal ligation and required no surgery. Mother-in-laws, who played a vital role in deciding the size of the family, were also brought on board.
Considering 44 per cent of the districts in India reported a high percentage of women marrying before turning 18, perhaps this ‘contraceptive couple’ team strategy could be tweaked to reach out to adolescents as well. Secondly, adolescent fertility rates in India remain high at 14.1 per cent per 1000 women aged 15-19, according to UNFPA’s 2025 State of the World Population report, Real Fertility Crisis. Of the 118 districts in the country with high teenage pregnancies, Bihar tops the list with 19. The state has 23.39 million adolescents, comprising 28.2 per cent of its population. Worryingly, not many of them have accurate sexual and reproductive health (SRH) information. A Population Council study found that of the 10,400 adolescents interviewed in 36 out of 38 districts in Bihar, only 44 per cent of girls between the ages 13-14 and 56 per cent of boys aged 13-14 knew that a woman could not become pregnant after kissing or hugging and 10 per cent knew that a woman could get pregnant at first sex.
The study also found that 14.1 per cent of unmarried adolescent boys and 6.3 per cent of unmarried adolescent girls had premarital sex, and of them, 22 per cent of boys and 28.5 per cent of girls had premarital sex before 15. Further, a large proportion of adolescents in sexual relations with a romantic partner had engaged in unprotected sex. Gender equality plays a big role in making informed choices. If India is to fulfil its commitment to Family Planning 2030 and Sustainable Development Goals of providing equitable contraceptive choices to all marginalised communities, especially women and adolescents, it must accelerate its efforts.
(The writer is journalist writing on development and gender. Views are personal)
