Written by Dr. Abbha Dhuriya and Manish Barik, FRHS India
Family planning is often presented as a story of success in India. Coverage is high and services reach most districts. Yet “choice” remains narrow. Female sterilisation continues to dominate the method mix, especially for women. This reliance limits autonomy and places a heavy burden on permanent solutions. In this context, Chhaya, also known as Centchroman, stands out as a missed opportunity that policy has failed to fully embrace.
Chhaya is a non-hormonal oral contraceptive developed in India. Its dosing schedule begins with twice a week intake and later shifts to once a weekly use. While daily regimens of other contraceptive pills demand privacy, memory, routine and conditions that many women managing various responsibilities fail to adhere. Chhaya fits better by addressing these barriers by shifting from daily to weekly dosing schedule. The method also does not interfere with breastfeeding. Chhaya is affordable and cost-effective for public family planning programs, as it requires no special storage conditions and with reduced logistical burden, and is more manageable to supply for use in low-resource and outreach settings.
Family planning program in India continues to prioritize rapid fertility reduction through permanent methods, a pattern reflected in the dominance of female sterilisation within the national method mix. Data from national surveys repeatedly show that female sterilisation accounts for the majority (more than two thirds) of modern contraceptive use. Spacing between births is crucial for social well-being as it allows parents more time, energy, and resources for each child, improving their health, education, and development, while also empowering mothers to pursue careers or further education, strengthening families, and reducing poverty. However, it remain secondary, even though unmet need for spacing is high among young married women affecting health outcomes such as increased maternal risk and affect newborn survival. In terms of health it improves maternal nutrition, reduces anemia risk, and supports recovery between pregnancies. Infant outcomes also improve with adequate intervals which aligns with infant feeding goals of breastfeeding mothers once lactation is started.
Chhaya fits the needs of women who prefer birth spacing over permanent methods. Young married women who want to postpone their first birth often hesitate to use intrauterine devices in fear of pain, side effects, or the idea of an internal device. Similarly, hormonal pills raise concerns about weight change, mood shifts, or long-term effects. In contrast, Chhaya provides effective contraception without the common fears associated with hormonal pills or IUDs, and its predictable, long-term weekly regimen reduces the need for frequent facility visits, making it suitable for women in both rural and urban settings.
The problem lies less with the method itself and more with how programs introduce and support its use. Awareness of Chhaya remains limited in many districts, and women often learn about it only during counselling, with little explanation of expected menstrual changes in the early months. When irregular bleeding or missed doses occur without clear guidance on what to expect or how to restart, trust declines and discontinuation becomes common.
Supply problems reinforce this cycle, with stockouts in public facilities disrupting continuity and private pharmacies rarely stocking the pill, which limits options for women who prefer private care. Communication on Chayya are sparse and inconsistent across states, and partners and family members who shape decisions often lack accurate information. Provider training is also uneven across states, and many default to familiar methods such as sterilisation or intrauterine devices, leading to rushed counselling and shallow explanations. These failures compound and keep Chhaya on the margins.
A policy shift is required, with India moving from symbolic inclusion of Chhaya to active promotion within routine services. Training must reach all cadres, from doctors to nurses to community health workers, with counselling that clearly explains dosing schedules, common side effects, and missed pill management, supported by simple reference tools for busy clinics. Communication materials should use plain language and local dialects, with formats suited for low literacy settings.
Continuation support for users’ needs stronger focus, with simple reminder tools such as calendars or marked packs to reduce early drop off and mobile messaging where feasible to reinforce schedules. Supply systems should forecast demand accurately and ensure uninterrupted availability, since trust grows when women know the pill will be there next month. Monitoring must track continuation and reasons for stopping, not just new acceptors, so programs fix counselling gaps.
In this context, the role of the private and non-profit sector becomes critical. Foundation for Reproductive Health Services India (FRHS India), an affiliate of MSI Reproductive Choices, has worked since 2009 in India, to improve access, choice, and quality of reproductive health services for poor and hard to reach populations. Operating through fixed centers, outreach services, FRHS India has become one of the leading private providers of family planning services in India, guided by the principle of children by “choice”, not chance.
As part of its effort to expand contraceptive choice, FRHS India is integrating Centchroman into its family planning basket, offered as Chhaya in the public sector and Saheli in the private sector. To support this integration with evidence, FRHS India is undertaking a structured implementation study with technical guidance from MSI Reproductive Choices and academic support from Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India. The study is embedded within routine service delivery, allowing evidence generation from real world use rather than controlled conditions. By examining acceptability, continuation, and user experience, the study will address a critical evidence gap on non-hormonal oral contraception in India.
Chhaya is a practical and scalable option designed for the Indian context, not a niche method. Policy must reflect this through stronger counselling, reliable supply, clear communication, and higher provider confidence. This shift moves family planning away from compulsion and toward genuine “choice”, which India needs now.
