As India is on the brink of surpassing China to become the most populous country in the world, experts cite lack of literacy, awareness regarding contraception and abortions and economic factors among reasons for the spike in the population.

According to data from the National Family Health Survey, more abortions take place in urban areas, which is 4 per cent, compared to 2.5 per cent in rural areas.?The data stated that 1.9 per cent women with no schooling background went for abortions while 3.5 per women with 10-11 years of education opted for it.

The plans of making her daughter a doctor changed for Chaaya Devi after she had two more children. "Children are god's gift but what if you don't have money to raise them and it leaves your other children suffering too," said the 25-year-old, a mother of three children.

Devi, who is expecting her fourth child, works as a domestic help in Noida. She now worries about how to ensure a good life for her children.?"I consulted a government hospital doctor but she scolded me for getting pregnant again but she does not understand my consent is never taken,” said Devi, who lives in a joint family with her in-laws.

Her situation is not unique, millions of women due to stigma, lack of say in family matters and acceptance of spouses towards contraceptives are forced to continue having children even as India is on the brink of surpassing China to become the most populous country in the world. India's population crossed the 140 crore mark in January and is soon expected to surpass China's population.

Some estimates suggest that India's population might have already surpassed China but till the official census is conducted a definitive number cannot be given. Poonam Muttreja, Executive Director, Population Foundation of India, said for any nation, the goal of a lower population growth rate requires a high contraceptive prevalence, which can only be achieved by strengthening the provision of family planning and sexual and reproductive health services, including access to abortion services.

According to data from the National Family Health Survey-5, 0.9 per cent of all pregnancies resulted in abortion in India. However, more abortions take place in urban areas - which is 4 per cent, compared to 2.5 per cent in rural areas, according to the latest NFHS data. In terms of economic background, 1.7 per cent of women from the lowest wealth quintile used abortion services compared to 3.2 per cent in the middle wealth quintile and 4.1 per cent in the highest wealth quintile, the data stated.

"What it means is that women who are less educated, or belong to poor and marginalised sections of society, are not able to use abortion services as well as their more affluent, more educated counterparts. This is partly due to the stigma that is associated with abortions and also the lack of access and availability of services to rural women," Muttreja said.

"Stigma forces women to seek services from quacks and untrained professionals which leads to maternal mortality and morbidity," she said.?Even though India has very progressive abortion policies, according to a 2015 study published in the Lancet, 15.6 million abortions occur in India annually, 95 per cent of which are outside public health facilities.

In India, abortion has been legal for more than half a century since the Medical Termination of Pregnancy Act, 1971. A recent judgement by the Supreme Court of India, delivered in 2022 advanced women’s right to abortion by including unmarried women among those who can seek abortion services.

India needs to step up on all its health and reproductive health services, including abortion services, and make sure it is available through qualified practitioners in government and private settings, Muttreja said. She suggested that another area where improvement is needed is the quality of family planning services.

Seema Bhaskaran, Lead-Gender at NGO Transform Rural India Foundation, said adolescents and young women are only infused with patriarchal values of virginity and the sanctity of the vagina and linking it to the honour of the family. "This leads to a sense of secrecy and shame about the body, menstruation, fertility, and reproductive rights," she said.

Talking about the situation in rural India, Bhaskaran said sexual abuse of adolescents and young women is high in rural areas of India and the girl children are subjected to severe trauma and risk to life as they bear children as unwed mothers.

"The body and mind of the adolescent are subjected to irreparable damage. Infant mortality and maternal mortality are repercussions of such violations and abusive experiences. Similarly, within marriages, women are subjected to marital rape and unwanted pregnancies and unable to exercise their rights for abortion," she said.

Information on these aspects is inaccessible for adolescents and young women either through anganwadis or health systems like sub-centres or primary health centres or through platforms of the National Health Mission and sparse information on menstrual hygiene is transmitted through adolescent groups which are dwindling in numbers, she said.

Scientific and technically correct information on control over the body, sexuality, reproductive rights, and family planning should be imparted through platforms like community-based organisations with the support of NHM, she added.

Shyamal Santra, Lead of Public Health and Nutrition at Transform Rural India Foundation said it is possible that the lower reported rates of abortion among lower-middle-class individuals in India could be influenced by a variety of factors, including limited access to healthcare, cultural or religious beliefs, or a lack of awareness about reproductive healthcare options.

"It is important to note that regardless of the reported rates of abortion, all individuals should have access to safe and legal reproductive healthcare services, including contraception and abortion if they choose to use them," Santra said.