Adyasha Priyadarshini and Harshita Umesh

We all grow up learning that questions about our bodies are better left unasked. From menstrual cramps and types of contraception (briefly mentioned in our textbooks and often shyly skipped), to questions around gender-affirming care. And yet, we find ourselves more comfortable asking ChatGPT than our healthcare providers.

Doctors often see this hesitance and shamed silence walk into their clinics every day: Young people who have lived with pain, confusion, or fear for years because no one ever gave them the language or permission to speak. Conversations on Sexual and Reproductive Health and Rights (SRHR) continue to be heavily censored. With this censorship grows a generation where discomfort is normalised and curiosity is discouraged.

By framing SRHR as purely “medical,” a thing to only be addressed within the four walls of the clinic, our perspectives narrow. We miss the various aspects of life influencing it. SRHR then shifts from being a quality of life issue to something spoken about in hushed tones and searched for in secrecy. In this narrowing of the conversation, care becomes clinical rather than human. But a prescription cannot fix a lack of autonomy, and a diagnosis cannot account for the environment we survive in.

To protect dignity, ensure safety, and reduce adverse healthcare outcomes, it becomes crucial to look beyond the clinic and examine the compounded factors that shape access and agency for all.

The Politics of Bodies

In India, this discourse is also shaped by layered discrimination rooted in caste and class. Caste does not just determine social standing. It often decides who is treated with dignity in a labour room and who is ignored. Access to care depends less on medical need and more on social permission.

This imbalance is reinforced by patriarchy. Women and gender-diverse people are frequently denied control over their own bodies, with healthcare decisions filtered through families and community gatekeepers rather than individual consent. The consequences of this loss of agency are visible in the data.

According to analyses of the National Family Health Survey (NFHS-5), modern contraceptive use among married adolescent girls remains low, at around 19%, while it is substantially higher among women in their early thirties, where prevalence is closer to two-thirds of women. The gap is not a lack of information, but a lack of autonomy.

Judicial systems also worsen these barriers in less visible ways. Although abortion is legal in India, access is often restricted by social norms, medical gatekeeping, and fear of legal scrutiny rather than the law itself. Complex procedures, provider bias, and moral policing delay time-sensitive, often life-saving services like abortion.

For transgender individuals, exclusion runs even deeper. Persistent gaps in data, repeatedly noted by the World Health Organization and UNAIDS, leave health systems ill-equipped to provide respectful, gender-affirming care.

The Social and Economic Web

The narrow understanding of  SRHR underscores the need for reformed policies and programmes which account for the social and economic conditions that shape life outcomes. Education provides a working example. Analysis of NFHS-5 data shows that girls with little or no education are 12 to 15 times more likely to marry before the age of 18 than those who attain higher education. Early marriage, in turn, raises the risks of early pregnancy, maternal mortality, and lifelong health complications.

This silence extends beyond classrooms. A 2025 UNESCO report shows that SRHR education doesn’t increase risky behaviours. It further states that multi-component programmes are particularly important for reaching marginalised young people, including those who are not in school.

But when schools avoid comprehensive sexuality education, adolescents are left to find answers on their own. Many turn to digital platforms for anonymity, only to encounter misinformation. The result is an increasing mental health burden, where unintended pregnancies, unsafe abortions, and stigma are navigated alone.

The consequences are not only social, but economic. According to estimates by the Guttmacher Institute’s Adding It Up analysis for India, providing a comprehensive sexual and reproductive health package to all adolescent girls would cost just over 11 rupees per capita annually.

The same analysis shows that every additional 100 rupees invested in contraceptive services could save 252 rupees in maternal and newborn care. Ignoring SRHR, therefore, does not just harm individuals, but weakens labour participation, productivity, and long-term economic growth.

The Climate Threat

Even the ground beneath us is shifting. The climate crisis threatens to undo decades of hard-won progress, revealing how closely reproductive justice is tied to environmental justice. Rising temperatures and extreme heat are directly linked to adverse pregnancy outcomes, increasing the risk of higher Maternal and Infant Mortality Rates.

During floods and climate-induced displacement, water scarcity turns menstrual hygiene management from a routine act into a daily struggle for dignity. Disasters also heighten risks of early marriage, gender-based violence, and trafficking. When climate responses overlook SRHR, they fail those who have contributed the least but are affected the most by environmental breakdown.

When Silence Protects Harm

And yet, conversations around SRHR happen in private allowing harmful practices to continue unchecked. For example, child, early, and forced marriage are often justified as a response to economic insecurity. Female genital mutilation persists in specific communities, shielded by silence and harmful cultural norms with lasting consequences. Addressing these only as medical emergencies misses the larger failure of our socio-political systems. These are NOT isolated acts, but symptoms of a system where bodies are regulated by community authority rather than autonomy.

A Call for Governance Reform

The changing global landscape threatens to roll back decades of progress. To resist this, governance must be colead with youth and shift systems must be shifted to be survivor-centric. SRHR cannot and should not remain the sole responsibility of health ministries. Silos must be broken through coordinated implementation across Health, Education, Women and Child Development, Labour, and Climate sectors.

Success should not be measured by clinic footfall alone, but by whether people can live with dignity, agency, and safety. Until sexual and reproductive health is treated as a whole-of-life issue, embedded in education, livelihoods, and climate resilience, policy will continue to fall short.

SRHR is not just about survival. It is about the right to live a great life – fully informed, and without fear.