The decline in modern contraceptive use alongside rising traditional methods in NFHS-6 raises concerns about quality of family planning services. Discuss.

NFHS-6 (2023-24) shows that contraceptive use among currently married women rose from 66.7% to 69.1%. Over the same period, modern-method use fell from 56.4% to 52.7%, and traditional methods rose by about 6 percentage points [1]. More women are using contraception, but their protection is less reliable. This points to a gap in the quality of services, not only in access to them.

Nature of the shift

• Headline hides a decline: all of the 2.4-point rise, and more, came from traditional methods such as rhythm and withdrawal. These methods fail more often [1].
• Unmet need fell by 1 point [1]. But unmet need counts only women using no method at all. A woman who switches to withdrawal is counted as "met" even though her protection is weak.

Why it signals poor service quality

• Weak counselling: failure rates of traditional methods are rarely explained. Fear of side-effects of modern methods also goes unaddressed, so women drop them.
• Narrow method basket: services rely heavily on female sterilisation (36.5%) [1]. Spacing methods (pills, IUCD, injectables) get less attention.
• Male disengagement: male sterilisation is only 0.5% [1]. This is despite the annual Vasectomy Fortnight every November and No Scalpel Vasectomy (NSV) training for providers [2]. Men are reached through short campaigns, not all year.
• Gendered burden: norms treat contraception as the woman's job. When a method fails, she also carries the unintended pregnancy and its health risks.

The other side

• Higher overall use and lower unmet need are real gains [1].
• Some couples may be making an informed choice to use non-invasive methods. Under a rights-based approach, that choice must be respected. Coercion or targets are not the remedy.

Way forward

• Explain how well each method works at every health contact, and widen access to spacing methods.
• Counsel couples together all year, instead of relying on a single fortnight [2].
• Prepare testing, approval and delivery pathways for reversible male contraceptives. WHO has set benchmarks for these for the first time [1].
• Monitor method mix and discontinuation, not just prevalence.

NFHS-6 shows that India has extended the reach of contraception but not its reliability or fairness. The programme's yardstick should move from "how many use" to "how well protected, and by whose effort". Informed choice, effective methods and responsibility shared between men and women would make the rights-based approach real and advance SDG 3.7 on universal reproductive healthcare.