Whose Bodies, Whose Choices? Postpartum Contraceptive Coercion And The Regulation Of Marginalized Women’s Fertility In India

Aparna Misra

Introduction

A woman who had recently given birth to her first child at a government hospital in Delhi was distraught to discover that she had been fitted with an IUD without her knowledge and prior consent. Her appeals for help to ease her discomfort and pain as a result of the insertion of the device were disparaged, and she was asked to seek further treatment at a private facility. This reality is not anecdotal and points towards a silent crisis of consent in India’s family planning programme.

Over the past decade, several cases from across the country—from Kolkata, Madhya Pradesh, and Tamil Nadu to Delhi—have exposed the practice of postpartum contraceptive coercion in government hospitals. While each case is usually treated as an isolated lapse or an aberration, together they reveal systemic problems of weak accountability, target-driven performance pressures and a normalized disregard for women’s autonomy, all deeply embedded in India’s reproductive governance.

In a woman’s life childbirth is a deeply vulnerable moment; it is a time when women deserve to be treated with care, dignity and respect. Yet for many women in India, particularly those from poor, migrant, and minority backgrounds, the memory of this time becomes marred by coercion and control. Postpartum Intrauterine Devices (PPIUDs) and injectables are increasingly promoted as a part of the country’s family planning strategy, but troubling reports reveal that women are often left with little say in these decisions. The prevalence of such practices highlights the ways in which states, healthcare systems, cultural norms and social hierarchies intertwine to regulate women’s fertility.

The Demographic Paradox

India’s demographic profile has shifted decisively in recent years. According to the Sample Registration System (SRS) Statistical Report 2023, the country’s Total Fertility Rate (TFR) has fallen to 1.9, below the replacement level of 2.1 for the first time. Interestingly, the data signals that a decline in the fertility rate is not limited to urban populations but also extends to rural India, which has now reached a TFR of 2.1.

Among states and Union Territories, Delhi has recorded one of the lowest TFRs, at around 1.2, placing it far below the national average. These findings corroborateearlier National Family Health Survey-5 (NFHS) data (2019-2021), which reported Delhi’s TFR at 1.62, already well below the replacement level and second nationally in contraceptive adoptionprevalence following Chandigarh.

Despite these trends, postpartum contraceptive promotion continues to be pursued aggressively in government hospitals. This reflects the persistence of a population control mindset, where family planning continues to be framed as a demographic imperative rather than a matter of reproductive rights. The result is a paradox: while population growth anxieties have receded in aggregate terms, state and institutional practices continue to treat certain groups of women—most often from the marginalized communities—as “targets” whose fertility needs to be managed by state intervention.

This disjunction helps explain why the impulse to regulate women’s reproduction remains entrenched in policy and practice and how maternity wards have become strategic entry points for contraceptive interventions in the process. After childbirth women are physically and emotionally exhausted and often not in a state where they can carefully consider their options, understand the side effects of the various contraceptives and then make an informed decision. In this manner, the maternity ward becomes a site where consent is easily compromised.

Whose Bodies? Consent, Control, and the State’s Demographic Agenda

It is important to note that postpartum contraceptive coercion does not affect all women equally. It disproportionately affects those who are marginalized. Women from lower-economic backgrounds, religious minorities, and tribal communities have historically been the subject of population control programmes which have often been coercive.

The state’s development agenda has continued to be hinged on the rhetoric that frames these communities as “overpopulating” the nation, thereby justifying the need for coercive state intervention. Casting the fertility of women belonging to these communities as something to be managed invariably reproduces older eugenic logics under the guise of fostering development. The recognition of these intersectional and eugenic dimensions is critical to address the structural inequalities that determine whose bodies are controlled and whose choices can be dismissed.

Conclusion

Contraceptive technologies can play a crucial role in enhancing women’s bodily autonomy and agency; they have the potential to allow them to determine the trajectory of their lives, but only when they are offered as choices, not imposed upon as mandates. When contraceptive adoption is guided by demographic anxieties and implemented through coercion, contraception ceases to be a tool of empowerment and instead becomes a mechanism of regulation. For marginalized women in particular, such practices reproduce entrenched social hierarchies and carry eugenic undertones, conveying the message that some women’s fertility is more valuable than others.

Moreover, the long-standing narrative of a “population explosion” no longer reflects contemporary demographic reality in the country. Allowing these anxieties to persist in shaping reproductive health policy risks undermining women’s rights, as it pursues goals that are increasingly disconnected from empirical evidence. The way forward lies in a decisive shift from a target-driven approach to a rights-based framework grounded in the principles of reproductive justice. This requires a renewed focus on counselling, holding healthcare providers accountable to ethical standards, and ensuring that the voices of marginalized women inform policymaking and implementation. Unless such a shift occurs, the unresolved question will continue to haunt healthcare policy: Whose Bodies? Whose Choices?

References

Ahluwalia, S., & Parmar, D. (2016). From Gandhi to Gandhi: contraceptive technologies and sexual politics in postcolonial India, 1947–1977. Reproductive States: Global Perspectives on the Invention and Implementation of Population Policy.

India, H. R. W. (2012). India: target-driven sterilisation harming women. Human Rights Watch.

https://www.hrw.org/news/2012/07/12/india-target-driven-sterilization-harming-women

Indian Express. (2018, November 2). Madhya Pradesh: Tribal women allege insertion of a Copper-T birth control device without consent. The Indian Express. https://indianexpress.com/article/india/madhya-pradesh-tribal-women-copper-t-birth-control-device-without-consent-5431425/

International Institute for Population Sciences (IIPS), & ICF. (2021). National Family Health Survey (NFHS-5), 2019–21: India report. IIPS.

https://dhsprogram.com/pubs/pdf/FR375/FR375.pdf

Human Rights Law Network & Socio Legal Information Centre. (2018). Mistreatment and Coercion: Unethical Sterilization in India (M. Masih, S. Barpanda, & Z. Wynne, Eds.). Human Rights Law Network. https://slic.org.in/uploads/2018/10/Mistreatment-and-Coercion-Unethical-Sterilization-in-India-3.pdf

Ledbetter, R. (1984). Thirty years of family planning in India. Asian Survey, 24(7), 736-758.

Morgan, L. M., & Roberts, E. F. S. (2012). Reproductive governance in Latin America. Anthropology & Medicine, 19(2), 241–254.

Muttreja, P., & Singh, S. (2018). Family planning in India: The way forward. Indian Journal of Medical Research, 148(Suppl 1), S1-S9.

Office of the Registrar General of India. (2023). Sample Registration System (SRS) statistical report 2023. Ministry of Home Affairs, Government of India. https://censusindia.gov.in/nada/index.php/catalog/46172/download/50420/SRS_STAT_2023.pdf

Sreenivas, M. (2021). Reproductive politics and the making of modern India (p. 285). University of Washington Press.

Times of India. (2018, February 22). At government hospitals, women being given IUDs without consent. The Times of India. https://timesofindia.indiatimes.com/city/kolkata/at-government-hospitals-women-being-given-iuds-without-consent/articleshow/63021211.cms

Times of India. (2024, March 2). Delhi: Birth control device inserted without consent of patient at Kasturba Hospital. The Times of India. https://timesofindia.indiatimes.com/city/delhi/delhi-birth-control-device-inserted-without-consent-of-patient-at-kasturba-hospital/articleshow/123934588.cms

Aparna Misra is a doctoral research student at the Department of Political Science, University of Delhi. Her areas of interest include reproductive rights, adaptive preferences, bodily autonomy, and public health ethics. Her work primarily focuses on rethinking and broadening the conception of autonomy by questioning the deep-seated Eurocentric ‘individualist’ biases inherent in the discourse.

Disclaimer: All views expressed in the article belong to the author and not necessarily to the organisation.

Acknowledgements: This article has been written as a part of the Public Policy Qualitative Participatory Action Research Fieldwork Fellowship- Cohort 6.0, conducted by IMPRI, New Delhi. This work would not have been possible without the encouragement and keen insights of Prof. Vibhuti Patel [Chair & Course Director], Session Speakers and the Convenors and Coordinating team at IMPRI.