India’s total fertility rate (TFR) has fallen to 2.0, according to NFHS-5 data, and family planning programs have expanded access to contraceptive information and services. Today, most women can recognize methods like pills, condoms, injections, and Copper-Ts. However, there is a significant gap between awareness of these methods and their application. Knowledge about contraceptives is almost universal in India. 99 percent among currently married women and men ages 15 to 49, according to NFHS-5 data. Yet the same data shows this one in three Married women still do not use contraceptive methods.
While most participants recognized modern contraceptive methods, 64 percent believed they had harmful side effects and 66 percent believed regular use could cause medical problems in future pregnancies.
To understand this gap, Good Business Lab spoke to over a hundred migrant workers at a garment factory in June 2024. While most participants recognized modern contraceptive methods, 64 percent believed they had harmful side effects and 66 percent believed regular use could cause medical problems in future pregnancies.
One participant explained, “The doctor had told me that frequent use of injections as a contraceptive method could result in women being unable to become pregnant in the future.” They told me it was OK if the injection was only given once.’ This is not about a lack of awareness, but about acceptance and fear of the use of contraceptives. This is due to uncertainty and what women have heard in their communities about contraceptive use.
What are women afraid of?
In the survey interviews, women expressed specific concerns. Some believed that frequent use of condoms could cause damage to the genitals. One worker said: “Frequent use of condoms can cause problems for both the penis and vagina.” Another shared a relative’s story about inserting Copper-T: “My sister-in-law told me that after inserting Copper-T, blood appeared during intercourse.”
In most households, fertility has a high social value and even small doubts about infertility influence decisions.
These claims lack medical substantiation, yet they circulate through families, peers, and sometimes through incomplete or overcautious advice from health care providers. In most households, fertility has a high social value and even small doubts about infertility influence decisions. Because of these beliefs, some women do not use contraception until they are no longer having children, even if they need it for health reasons. They may forego contraception even when it could help them avoid pregnancy, delay pregnancy for important reasons, and protect their health.
The same pattern is also evident in maternity care. Workers said women in their villages often delayed prenatal visits. One worker said, “In my village, pregnant women go to the doctor only in the fifth or seventh month of pregnancy.” Another added: “People say you shouldn’t see a doctor until after three months.”
Several women also expressed distrust of hospitals. One participant shared that she gave birth to most of her children at home because she was afraid of institutional care, citing long discharge times and a lack of support. These stories demonstrate that women are hesitant to use contraception or seek appropriate maternal care because their personal experiences, advice from community members, and societal expectations, in addition to long-standing community beliefs, influence the way they interpret modern medical practices.
Menstrual stigma as a basis for low contraceptive use
Contraception fears Build on false beliefs about the body. In many communities to which the interviewed workers belong, menstruation is associated with many restrictions. Women may avoid kitchens or temples, sleep separately, or limit routine activities during their periods. In the survey, 72 percent considered menstrual blood to be unclean.
There is rarely an explanation for these limitations; They are simply observed and carried on from generation to generation without being questioned. When menstruation is treated as taboo, as something that should not be talked about, the same treatment extends to later stages of the reproductive cycle, such as contraception and prenatal care.
Menstrual taboos have been found to directly limit women’s knowledge and autonomy regarding contraception, pregnancy, and safe abortion, with stigma in girlhood shown to influence reproductive health outcomes well into adulthood.
Menstrual taboos were It has been found to directly limit women’s knowledge and autonomy regarding contraception, pregnancy, and safe abortion, with stigma in girlhood shown to influence reproductive health outcomes well into adulthood.
The Supreme Court recently directed the National Council of Educational Research and Training (NCERT) and the State Council of Educational Research and Training (SCERT). Integrate menstrual health into curricula through gender-appropriate content. This move aligns the dignity of menstruation with the rights protected by Article 21A and links it to dignity, equality, health and access to education.
Although the ruling focuses on adolescent girls, it also underscores a broader point: reproductive health is directly related to dignity and participation, and early taboos can influence future decisions. The ruling noted that “lack of physical literacy contributes to a sense of lack of bodily autonomy.”
The workplace as a safe space
If silence leads to fear, it raises an important question: Where can people have open conversations? For many migrant women, the workplace may be one of the few structured environments outside of home where open dialogue is possible. As part of the study, Good Business Lab worked with Project Baala, an organization specializing in sexual and reproductive health, to develop and test a training program for low-income migrant workers.
Women met in small groups over the course of weeks for regular, guided discussions. This gave them a safe and supportive place to talk about various topics such as pregnancy, menstruation, domestic violence, sexual harassment and more. Women spoke to peers who had similar migration backgrounds and similar family pressures. For many, it was the first time they had openly discussed these issues.
One participant said: “I feel like I have gained courage inside.” Women compared experiences, cleared up misunderstandings and questioned long-held beliefs. Earning wages also boosted their confidence in budget discussions. At work they found a space in which they could talk openly, engage with each other’s concerns and not feel judged during the discussion.
To know Gains after SRH training
Workers who received SRH training reported:
65.3% higher overall SRH knowledge than the control group
114% increase in menstruation-related knowledge, the largest increase observed
82% higher pregnancy-related knowledge
62% higher knowledge of contraception and STD prevention
33% higher knowledge of violence and harassment
These results show that conversations help people better understand sexual and reproductive health. Talking to others who have had similar experiences also offers important support.
Menstrual health as part of the right to life
The Supreme Court’s directions on menstrual health reflect that the responsibility for supporting menstrual health and dignity should not lie solely with women; The system must create supportive conditions and design spaces that help women. By mandating gender-sensitive curricula and institutional accountability, the ruling places responsibility on systems rather than individuals.
If menstrual health is critical for participation in education, it is equally important for entry into the workforce. However, legal rights alone are not enough to change outcomes unless women have an environment that supports informed decisions.
The path to the agency
There is a large gap between what women know about SRH and the agency they have regarding these issues. Myths about contraception and fears about pregnancy often mix with what they have learned about pregnancy from those around them. This gap affects their health and their ability to plan families while managing work.
To truly strengthen women’s agency, women need both knowledge of SRH and a supportive environment that gives them confidence and enables them to openly discuss their concerns.
Public health campaigns have helped raise awareness, but information alone does not change behavior. Cultural taboos make it difficult to ask questions. The lack of open acceptance and discussion makes these topics taboo. Brief medical consultations cannot undo years of caution passed down through generations.
To truly strengthen women’s agency, women need both knowledge of SRH and a supportive environment that gives them confidence and enables them to discuss their concerns openly. Otherwise, silence and old habits will continue to influence how they make reproductive decisions.
All quotes in this article are the authors’ free translation into English.
This article is based on a Good Business Lab study of more than 100 migrant women working in a garment factory. It explores why contraceptive fear and menstrual stigma continue to influence decisions even as awareness increases, and how the workplace can become an unexpectedly powerful space for change.
Sangeetha Esther is a senior research associate at Good Business Lab, a nonprofit research organization that tests solutions to improve worker well-being and business outcomes in labor-intensive industries.
Murchana Nath is a senior research associate at Good Business Lab, a nonprofit research organization that tests solutions to improve worker well-being and business outcomes in labor-intensive industries.