Contraception beyond access: barriers in uptake, perceived health risk and choice gaps in India

India has a long-standing family planning programme, yet contraceptive use remains characterised by reliance on female sterilisation, limited uptake of reversible methods, and high discontinuation of temporary contraception. Despite improvements in overall prevalence, access alone has not translated into sustained or equitable use. This narrative review synthesises epidemiological, qualitative, and policy-oriented evidence to examine how contraception-seeking behaviour in India is shaped by social norms, gendered decision-making, health-system practices, and perceptions of health risk, with particular attention to cancer-related fears. The literature indicates that contraceptive decisions are rarely individual choices, being embedded within marital expectations, fertility pressures, and constrained female autonomy. Fear of side effects, especially concerns about long-term health and cancer, deters uptake and continuation of hormonal methods despite evidence of limited, time-bound risks and substantial protection against ovarian and endometrial cancers. These concerns are reinforced by inconsistent counselling and provider bias, highlighting the need for behaviour-centred, rights-based family planning.