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In India, many couples turn to non-hormonal contraception to avoid potential side effects associated with hormonal methods or to preserve fertility for the future. While men and women of reproductive age are aware of at least one modern contraceptive option, the adoption of methods is heavily skewed toward female sterilisation.
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According to the latest National Family Health Survey (NFHS-5, 2019-21), 56.5% of married women between 15-49 are using a modern contraceptive method — an increase from 47.8% in 2015-16. Among those methods, permanent female sterilisation dominates, used by about 76% of women relying on modern contraception. Short-acting methods (such as condoms and oral pills) account for just over 20%, while long-acting reversible contraceptives (LARCs), such as IUDs, make up only about 3.2%.
Despite growing awareness and availability, non-hormonal or reversible non-systemic methods are under-utilised often because of low awareness, misconceptions, cultural norms, or limited counselling. Obstetricians and gynaecologists believe a broader range of non-hormonal contraceptives is feasible and acceptable, but current adoption remains patchy and uneven across States, education levels, and rural vs. urban populations.
Current options
The copper intrauterine device (IUD)– a T-shaped plastic device wrapped in copper wire that is inserted into the uterus, stands out as the first-line non-hormonal method in India. “Copper IUDs are more than 99% effective, reversible, and can last 5–10 years,” said R. K. Vidhya Lakshmi, lead consultant, obstetrics and gynaecology, SRM Global Hospitals, Chennai. Girija Ashok Kumar, consultant obstetrician & gynaecologist, VS Hospitals, Chennai added that insertion takes only minutes in a clinic.
Condoms remain the most accessible option, inexpensive and protective against sexually transmitted infections (STIs). Yet, as Shobana Priya S., senior consultant, Institute of obstetrics, Gynaecology & IVF, SIMS Hospital, Chennai noted, “their effectiveness varies if not used correctly and consistently.” Diaphragms, sponges, and female condoms are technically available, but as several doctors observed, they are rarely used due to lack of awareness, fitting requirements and availability in India.
Less widely known is Centchroman, a weekly non-hormonal pill available in India. “It is well tolerated, taken once a week, and fertility returns quickly after stopping,” explained Dhivya Sharona, consultant obstetrics & gynaecology, Rela Hospital, Chennai.
Fertility concerns and solutions
Experts stressed that contraceptive methods themselves do not cause long-term infertility. Instead, age remains the biggest factor. “Couples often ask me if the copper IUD will make them infertile later. The answer is no, and fertility returns once it’s removed. The real risk is delaying pregnancy into the mid-30s,” said Dr. Girija, pointing out that there needs to be better awareness about the biological limits of postponing childbirth.
For couples planning children later, barrier methods or reversible devices such as the copper IUD are preferred. Dr. Dhivya recommended combining fertility awareness with condoms for added protection, but advised that fertility testing (such as AMH and AFC levels) may help guide decisions when delaying parenthood.
For families that are complete, sterilisation remains a reliable non-hormonal choice. “Tubectomy in women or vasectomy in men are safe and effective, but they are permanent and must be taken up only after thorough counselling,” said Dr. Shobana Priya.
Consent and readiness are critical. “I always sit both partners down, ask if they are convinced, check their age and health; consent matters more than the procedure itself,” explained Dr. Girija. Dr. Dhivya emphasised that reversal surgeries exist but are only partly effective, with success rates of 40–60%.
The role of men
Doctors stressed that men’s participation has been limited, and that needs to change. Vasectomy, a safe and quick procedure, remains underused due to stigma. “Myths about loss of strength still prevent men from choosing vasectomy, though none of that is true,” said Dr. Girija.
India has also contributed to global research. RISUG (Reversible Inhibition of Sperm Under Guidance), developed in India, is in late-stage trials. “It is a one-time injection into the vas deferens that blocks sperm passage and is potentially reversible,” explained Dr. Dhivya. Other experimental methods — including Vasagel, hydrogel implants, and non-hormonal pills are still being researched.
Each method carries advantages and trade-offs. Condoms are cheap, accessible, and protective against STIs but prone to user error. Copper IUDs provide long-term protection but may increase bleeding and cramps. Diaphragms and female condoms are reusable and hormone-free but require proper technique and remain niche.
Dr. Vanitha Shri R., senior consultant, obstetrics, gynaecology and fertility specialist, MGM Healthcare also flagged rare risks of IUDs, such as expulsion, infection, or uterine perforation, and emphasised that insertion requires trained providers. Meanwhile, she noted condoms’ drawbacks such as slippage, latex allergies, and reduced sensitivity.
Breaking contraceptive barriers
Natural fertility awareness methods are often viewed as “side-effect free” but carry high failure rates. Apps and digital tools have made tracking cycles, basal temperature, and ovulation easier. Yet their reliability is still low for contraception. “Cycles get disturbed by stress, illness, travel—failures happen. For high protection, don’t rely only on apps,” advised Dr. Girija.
Dr. Vanitha Shri noted that these methods are not suitable for women with irregular cycles. Dr. Dhivya added that only validated apps should be used, as many available tools are designed towards fertility prediction rather than prevention.
New global options
Globally, new non-hormonal options are expanding. Vaginal pH-modulating gels such as Phexxi, zinc or biodegradable IUDs, improved diaphragms, anti-sperm antibodies, and vitamin C–based vaginal rings are under development. “Research is ongoing into vaginal gels, advanced IUDs, and non-hormonal male pills. If proven safe and affordable, India can adopt them,” said Dr. Shobana Priya.
From fears of IUDs “moving inside the body” to taboos around vasectomy, social perceptions weigh heavily. “Honest counselling and clear answers change outcomes more than the method itself,” said Dr. Girija.
Non-hormonal contraception will expand further when newer technologies reach clinics and when men share equal responsibility in family planning. Until then, improving awareness and access to existing options remains the most immediate need, experts emphasised.
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