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. 2026 Sep 2;19:11786329261471746. doi: 10.1177/11786329261471746

Voices, Choices, and Access: A Narrative Review of Reproductive Health Awareness and Strategic Schemes in India and Beyond

Rohit Raj 1, Jarina Begum 1,✉, Syed Irfan Ali 1, Manasee Panda 2, Vani Lakshmi R 3, Takkella Nagamma 4
PMCID: PMC13539039  PMID: 42694522

Abstract

Introduction

Reproductive health awareness is a fundamental component of public health, gender equity, and human rights. This narrative review aimed to systematically describe and synthesise evidence on reproductive health awareness among tribal women and adolescent girls in India and internationally, examine major reproductive health schemes implemented in India, and identify strategies to strengthen awareness and service utilisation.

Material and Methods

A structured narrative review was conducted in accordance with the Scale for the Assessment of Narrative Review Articles (SANRA) guidelines. Literature published between January 2005 and January 2026 was identified through PubMed, Scopus, Web of Science, and Google Scholar. Peer-reviewed articles, review papers, policy documents, and relevant grey literature published in English were eligible for inclusion. Studies focusing on reproductive health awareness among tribal or Indigenous women and/or adolescent girls were screened and synthesised thematically. A total of 36 evidence sources were included in the review.

Results

A total of 36 studies were included. International and Indian evidence consistently demonstrates lower reproductive health awareness among tribal populations. Awareness of at least one modern contraceptive method among tribal women ranged from approximately 55-90% across studies, while utilisation remained substantially lower (20-60%), highlighting a persistent awareness-utilisation gap. Partial knowledge, menstrual stigma, gendered decision-making, and reliance on traditional practices were common across contexts. Although awareness of government schemes such as JSY, JSSK, and PMMVY was moderate to high, utilisation remained variable, revealing a persistent awareness-utilisation gap.

Conclusion

Reproductive health awareness among tribal women and adolescent girls is shaped by complex socio-cultural and structural determinants. Strengthening culturally responsive health communication, adolescent-friendly services, community engagement, and frontline health worker capacity is essential to improve awareness and equitable utilisation of reproductive health services and schemes. The findings provide policy-relevant evidence to guide tribal health programmes and support progress toward reproductive health equity.

Keywords: reproductive health awareness, India, adolescent girls, maternal health, menstrual hygiene, tribal women

Introduction

Reproductive health awareness is globally recognised as a fundamental pillar of public health, gender equity, and human rights. The World Health Organisation (WHO) defines reproductive health as a state of complete physical, mental, and social well-being in all matters relating to the reproductive system, rather than merely the absence of disease or infirmity. 1 This comprehensive definition underscores the importance of informed decision-making, access to accurate information, and the availability of quality, acceptable, and culturally appropriate reproductive health services throughout the life course. Adequate reproductive health awareness empowers individuals, particularly women and adolescents, to exercise autonomy over their reproductive choices, contributes to improved maternal and neonatal outcomes, and supports broader social and economic development. 2

Globally, significant progress has been made in advancing sexual and reproductive health and rights (SRHR) through international commitments such as the International Conference on Population and Development (ICPD) Programme of Action and the Sustainable Development Goals (SDGs), particularly SDG 3 (good health and well-being) and SDG 5 (gender equality). 3 Despite these advancements, substantial inequities persist, especially among marginalised populations. Indigenous and tribal communities across low, middle, and high-income countries continue to experience a disproportionate burden of poor reproductive health outcomes, including higher rates of maternal mortality, adolescent pregnancies, anaemia, unmet need for contraception, and limited utilisation of antenatal and institutional delivery.2,4 These disparities are often rooted in historical marginalisation, structural inequities, socio-cultural norms, linguistic barriers, geographic isolation, and persistent mistrust of formal health systems.

International evidence consistently demonstrates that Indigenous women and adolescent girls have lower levels of reproductive health knowledge and face greater barriers to accessing timely and appropriate services compared to non-Indigenous populations. Factors such as limited health literacy, inadequate culturally sensitive health communication, gendered power relations, and discrimination within healthcare settings further compound these challenges. 5 Moreover, reproductive health awareness among adolescents in tribal and Indigenous settings is frequently constrained by social taboos surrounding menstruation, sexuality, and contraception, resulting in delayed care-seeking, reliance on traditional practices, and adverse reproductive health outcomes.

In India, tribal populations officially classified as Scheduled Tribes (STs) constitute approximately 8.6% of the total population and are predominantly concentrated in rural, forested, and geographically hard-to-reach regions. 6 While India has achieved notable economic growth and made substantial investments in public health infrastructure, tribal communities continue to lag behind the general population across key health and human development indicators. National surveys have consistently reported higher maternal mortality, lower rates of institutional delivery, poorer antenatal care coverage, higher prevalence of adolescent marriage and pregnancy, and widespread micronutrient deficiencies among tribal women and girls. 7

Recognising these disparities, the Government of India has implemented several reproductive and adolescent health programs, including Janani Suraksha Yojana (JSY), 8 Rashtriya Kishori Swasthya Karyakram (RKSK), 9 Poshan Abhiyan, 10 Anaemia Mukt Bharat, 11 and the Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCHN+A) strategy. Although these initiatives aim to improve service coverage and health outcomes, evidence suggests that gaps in awareness, sociocultural acceptability, frontline health worker outreach, and contextual adaptation continue to limit their effectiveness among tribal populations. Persistent inequities in knowledge and utilisation indicate that programmatic success cannot be achieved through service provision alone, without addressing underlying awareness and structural barriers. 12 Against this backdrop, synthesising existing evidence on reproductive health awareness among tribal women and adolescent girls is critical.

Although several systematic and scoping reviews have examined individual aspects of reproductive health among Indigenous populations, no review to our knowledge has integrated evidence on reproductive health awareness, major reproductive health schemes, and implementation challenges across both Indian tribal and international Indigenous contexts. This narrative review addresses this gap by providing a broad synthesis of awareness-related determinants and policy implications.

This review aims to systematically describe the concept, scope and determinants of reproductive health awareness among tribal women and adolescent girls in India and abroad. To review the major national reproductive health schemes implemented in India and to provide evidence-based recommendations for strengthening reproductive health awareness and scheme intervention. By consolidating available evidence, this review seeks to inform culturally responsive policies, strengthen programmatic strategies, and guide future research to advance reproductive health equity among tribal populations.

Operational Definition

Indigenous population: varies across countries and policy contexts. The term “Indigenous” is commonly used internationally to refer to populations with historical continuity to pre-colonial societies and distinct cultural, linguistic, and social identities. 13

Scheduled Tribes (STs): refer to communities officially recognised under Article 342 of the Constitution of India. Although the terms “tribal,” “Indigenous,” and “Scheduled Tribes” are not entirely synonymous, they are used in this review to describe populations experiencing comparable historical marginalisation, geographic isolation, and reproductive health inequities. 14

Reproductive health awareness: It refers to an individual’s knowledge, understanding, attitudes, perceived self-efficacy, and ability to access, interpret, and utilise information related to contraception, maternal health, menstrual health, sexually transmitted infections, and available reproductive health services and schemes.

Material and Methods

This narrative review was conducted based on the SANRA checklist 15 Details of the checklist mentioned in supplementary material 1.

Study Design: This review aims to synthesise and summarise the concept, scope, determinants, and existing evidence on reproductive health awareness among tribal women and adolescent girls in India and internationally.

Data Sources: A structured literature search was conducted between January 10, 2005 and January 25, 2026, across PubMed, Scopus, Web of Science, and Google Scholar (first 10 pages). Searches were limited to English-language publications published between January 2005 and January 2026.

Search Strategy: Search terms were developed using Medical Subject Headings (MeSH) and free-text terms. Boolean operators were applied. Key search terms included: “Reproductive health awareness”, “Sexual and reproductive health”, “Tribal women”, “Indigenous women”, “Adolescent girls”, “Menstrual hygiene”, “Maternal health”, “Family planning”, “India”, “Scheduled Tribes”, “Abroad”, “Low-Middle income countries”

Example PubMed search string: (“Reproductive health awareness” OR “sexual and reproductive health”) AND (“tribal women” OR “indigenous women”) AND (“adolescent girls” OR adolescents).

Inclusion Criteria

Peer-reviewed original research articles, grey literature including government reports and websites in India, and review papers. Studies focusing on tribal/Indigenous women and/or adolescent girls. Studies addressing reproductive health awareness or related domains. Articles published in English. Studies conducted globally or in India, and studies published over the last 20 years, were included. The 20-year timeframe (2005-2026) was selected because this period corresponds with major global and national reproductive health initiatives, including the MDGs, SDGs, RMNCHN+A strategy, RKSK, and expanded Indigenous health policies internationally. Including this period enabled examination of awareness trends across evolving policy contexts.”

A total of 1277 records were identified through database searching and additional sources. After removal of duplicates and screening of titles and abstracts, 147 articles underwent full-text assessment. Of these, 36 studies met the inclusion criteria and were included in the narrative synthesis. Screening and eligibility assessment were conducted by the first author, with uncertainties regarding inclusion resolved through discussion with a senior researcher. Given the narrative review design, no formal risk-of-bias assessment was undertaken. Although 36 studies were included, the review employed intentionally narrow eligibility criteria focused specifically on reproductive health awareness among tribal and Indigenous women and adolescent girls. Many studies addressing reproductive outcomes without awareness-related measures were excluded.

Editorials, commentaries, and opinion pieces, studies not explicitly addressing awareness or knowledge, clinical trials unrelated to reproductive health education, and studies focused exclusively on non-tribal populations were excluded.

Data Extraction and Synthesis

Relevant studies were screened by title and abstract, followed by full-text review. Data were extracted on the study setting, population, key findings, and thematic focus. A thematic synthesis approach was used to categorise findings into major domains. A detailed data extraction sheet is mentioned in supplementary material: Characteristics of the study.

Results

This narrative review included a total of 36 pieces of evidence, including empirical studies, reviews, and policy documents published between 2005 and 2025. Details of the screening process are mentioned in Figure 1: Flow diagram of study identification and selection for the narrative review. The evidence comprised cross-sectional quantitative studies, qualitative and mixed-methods research, systematic and scoping reviews, and national and global programme documents. Studies were conducted across Latin America, South and Southeast Asia, Sub-Saharan Africa, Australia, and high-income settings, with several analyses based on nationally representative survey data. Study populations primarily included adolescents, women of reproductive age, Indigenous and tribal communities, and selected stakeholders such as teachers and healthcare providers. The literature addressed sexual and reproductive health awareness, contraceptive use, menstrual health, maternal and child healthcare utilisation, adolescent health, and ethnic or Indigenous health inequalities. Sample sizes ranged from small qualitative studies to large secondary datasets; review and policy documents did not report sample sizes.

Figure 1.

Figure 1.

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Flow diagram of study identification and selection for the narrative review

1. Family Planning Awareness and Reproductive Autonomy

International Evidence

Empirical evidence from diverse international settings consistently demonstrates low levels of sexual and reproductive health (SRH) awareness among Indigenous and rural populations. Studies conducted in Indigenous-dominated regions of Latin America, including Mexico and Guatemala, report limited understanding of reproductive physiology, contraception, and available SRH services, despite expressed interest in receiving culturally tailored education.16-18 Among Indigenous adolescents, awareness gaps are particularly pronounced. Research from Chiapas, Mexico, indicates that while adolescents acknowledge their right to sexuality education, practical knowledge remains limited, especially among Indigenous language speakers and those from socioeconomically disadvantaged households.17,19,20 A global systematic review of rural adolescent reproductive health identified multi-level barriers ranging from misinformation and stigma to weak adolescent-friendly health services that constrain awareness across settings, including Indigenous populations. 21 International literature consistently reports awareness of at least one modern contraceptive method ranged from approximately 55-90%, whereas detailed knowledge of method effectiveness, side effects, and reproductive rights was substantially lower. Although awareness of at least one modern contraceptive method is often reported in low- and middle-income countries (LMICs), detailed knowledge regarding correct use, side effects, method choice, and reproductive rights remains limited.22,23 Consequently, awareness frequently fails to translate into sustained contraceptive use.

Evidence from Indigenous populations in Guatemala, Peru, Bolivia, and Mexico indicates persistently low uptake of modern contraceptives despite national improvements in family planning coverage.24,25 Barriers include geographic isolation, inconsistent availability of preferred methods, language discordance between providers and users, and sociocultural norms favouring high fertility. Decision-making related to contraception is often mediated by male partners or elders, limiting women’s reproductive autonomy. 20

Similar disparities are observed among Indigenous and ethnic minority populations in Southeast Asia. Studies from Vietnam and Indonesia report lower contraceptive prevalence and poorer family planning knowledge among Indigenous women, even in regions with established primary healthcare systems. 26 Indigenous adolescents demonstrate particularly low contraceptive literacy and limited access to adolescent-responsive services, contributing to early marriage and unintended pregnancies.

Notably, these inequities persist in high-income G20 countries. Research among Aboriginal and Torres Strait Islander women in Australia and First Nations women in Canada documents lower contraceptive literacy, higher adolescent pregnancy rates, and inconsistent engagement with family planning services, attributed to historical marginalisation, mistrust of health systems, and insufficient culturally safe care. 27

Indian Evidence

The narrative synthesis of the included literature identified consistent patterns in reproductive health awareness among tribal women and adolescent girls across international and Indian contexts. Findings were organised into thematic domains reflecting awareness levels, socio-cultural determinants, service utilisation, and emerging intervention approaches.

Indian studies indicate that awareness of at least one modern contraceptive method among tribal women is relatively high in certain regions. However, this awareness frequently does not translate into sustained contraceptive use. Key barriers reported across studies include limited availability of contraceptives at peripheral health facilities, geographic distance to services, sociocultural resistance, and gendered decision-making within households. Regional variation is evident, with fertility preferences shaped by social organisation, kinship structures, and prevailing gender norms. Higher educational attainment among women and their partners, along with improved socioeconomic status, is consistently associated with increased contraceptive acceptance and use.28-30

2. Menstrual Health and Adolescent Reproductive Health

International Evidences

International evidence reveals correct menstrual knowledge ranging from approximately 30-70%, with hygienic absorbent use varying widely across menstrual health knowledge and adolescent reproductive health awareness among Indigenous girls. Studies across LMICs report limited understanding of menstruation as a biological process, widespread stigma, and adherence to restrictive cultural practices. 31 Indigenous adolescent girls frequently rely on informal sources of information due to limited school-based sexuality education and sociocultural discomfort surrounding reproductive topics. 32

Research from sub-Saharan Africa and Latin America documents the use of unhygienic menstrual absorbents, inadequate water and sanitation facilities, and high rates of school absenteeism during menstruation among Indigenous girls. 32 These challenges are compounded by poverty, geographic isolation, and weak adolescent-focused outreach.

Beyond menstruation, awareness of puberty, fertility, sexually transmitted infections, and pregnancy risk remains inadequate. Studies from Indigenous populations in Latin America and Australia link the absence of comprehensive sexuality education to early sexual debut, low contraceptive use, and increased vulnerability to unintended pregnancy. Even in high-income contexts, Indigenous adolescents demonstrate lower sexual and reproductive health literacy compared with non-Indigenous peers.33,34

Indian Evidence

The reviewed literature demonstrates persistent gaps in menstrual health awareness and practices among tribal adolescent girls. Several studies report widespread use of unhygienic menstrual absorbents, adherence to restrictive cultural practices during menstruation, and limited understanding of reproductive physiology. 35 Menstrual-related morbidities, including gynaecological symptoms, are commonly documented. While some settings report moderate knowledge levels, health-seeking behaviour remains low, with limited engagement with formal healthcare services for menstrual or reproductive concerns. 36

Qualitative and community-based studies highlight the lack of structured sexuality education and limited prioritisation of adolescent sexual and reproductive health and rights (SRHR), particularly in tribal-dominated and resource-constrained regions. 37

3. Maternal and Child Health Awareness

International Evidences

International literature consistently identifies substantial gaps in maternal and child health (MCH) awareness and uneven utilisation of services among Indigenous women. Despite global improvements in MCH indicators, Indigenous populations continue to experience higher maternal and neonatal morbidity and mortality. 3 Awareness of key maternal health components, such as early pregnancy registration, recommended antenatal care visits, danger signs, and postnatal follow-up, remains limited in many Indigenous settings. 20

Across LMICs, utilisation of antenatal care, skilled birth attendance, and postnatal services among Indigenous women is consistently lower than national averages. 19 In high-income countries, similar disparities persist. Aboriginal and Torres Strait Islander women in Australia and First Nations women in Canada demonstrate lower engagement with early antenatal care and poorer outcomes despite universal health coverage. 34 Child health awareness and immunisation uptake are also lower among Indigenous populations. Studies indicate reduced knowledge of immunisation schedules and infant feeding practices, contributing to lower vaccination coverage and higher preventable morbidity among Indigenous children globally. 38

Indian Evidences

Evidence from multiple Indian states reveals substantial socio-economic and geographic disparities in maternal and child health (MCH) service utilisation among tribal women. 39 Although institutional delivery rates have improved in several regions, early pregnancy registration, completion of recommended antenatal care (ANC) components, and postnatal care utilisation remain inconsistent. 40 Avoidance of iron-folic acid supplementation due to perceived side effects, reliance on traditional practices, and limited awareness of comprehensive ANC services and adhere to Iron Folic Acid tablets were 53-81% are frequently reported. 41

Educational status, household economic conditions, geographic accessibility, and perceived quality of healthcare services emerge as key determinants of service uptake. Notably, some remote tribal regions report relatively high institutional delivery and ANC utilisation despite infrastructural barriers, reflecting contextual heterogeneity in health-seeking behaviour. 42

However, findings were not uniform across settings. Some tribal populations reported comparatively high awareness of contraception and maternal health services, and several studies documented institutional delivery rates approaching regional averages, indicating substantial contextual heterogeneity.

4. Traditional Beliefs and Cultural Practices

Traditional beliefs and culturally embedded practices play a central role in shaping reproductive health awareness and health-seeking behaviour among Indigenous populations. Pregnancy and childbirth are often viewed as natural events requiring minimal medical intervention, reinforcing preferences for home-based deliveries and reliance on traditional birth attendants.19,43 Menstrual taboos, notions of impurity, and gender norms restrict open discussion and formal education on reproductive health. 44

Traditional healers and Indigenous knowledge systems remain influential sources of reproductive health guidance. While these systems provide culturally resonant support, exclusive reliance may delay timely referral to biomedical care for complications. 22 Overall, international evidence underscores that reproductive health awareness among Indigenous women and adolescent girls is shaped by complex interactions between cultural norms, socioeconomic disadvantage, geographic isolation, and systemic health system inequities. A review of maternal and child health practices among tribal women in Maharashtra found that strong traditional beliefs and trust in traditional birth attendants (dais) contribute to poor utilisation of formal maternal and child health services and preferences for home delivery for ritual requirements. Unhygienic cord care and delayed breastfeeding were also documented. 45 Pregnancy and childbirth in the area follow well-established traditional practices, including specific dietary customs, migration to the maternal home for delivery, home-based births, and reliance on traditional healers before seeking formal care. Rituals surrounding labour, newborn care, cord disposal, and postnatal isolation reflect cultural beliefs about protection, purity, and risk during the perinatal period. 46

A systematic scoping review from tribal communities in Odisha highlights that local healers (disaris/vaidyas) using Indigenous herbal and ritual practices remain central to how health issues are addressed, and the persistence of these practices delays or reduces engagement with modern healthcare services12.

5. Awareness and Utilisation of Reproductive Health Schemes in India

The reviewed literature demonstrates variable awareness and uneven utilisation of government reproductive and maternal health schemes among tribal women and adolescent girls in India. Awareness of JSY and JSSK reported in the included studies generally ranged from approximately 50-85% among eligible women, although detailed knowledge of eligibility criteria and entitlements was considerably lower. 47 Utilisation of conditional cash transfer and service-based programs, including Pradhan Mantri Matru Vandana Yojana (PMMVY) and Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA), shows marked inter-state and intra-district variation, influenced by literacy, socioeconomic status, geographic accessibility, and frontline worker engagement.48,49

Nutrition and adolescent-focused initiatives such as Anaemia Mukt Bharat, Poshan Abhiyaan, and Rashtriya Kishor Swasthya Karyakram (RKSK) report suboptimal reach among tribal adolescents, constrained by menstrual stigma, weak school and community-based outreach, and limited adolescent-friendly services.9-11 This scheme shows a relatively higher coverage but variable quality and continuity of care. Overall, an awareness-utilisation gap persists, highlighting the need for culturally sensitive, community-engaged, and health-system-responsive implementation strategies.

Discussion

This narrative review synthesises international and Indian evidence on reproductive health awareness among tribal and Indigenous women and adolescent girls, highlighting persistent and intersecting inequities across socio-cultural, economic, and health system dimensions. Despite substantial global and national policy commitments to sexual and reproductive health and rights (SRHR), the findings demonstrate that awareness and effective utilisation of reproductive health services remain uneven and contextually constrained.

The Discussion Is Organised Under the Following Subheadings

Convergence of Global and Indian Evidence

A key finding of this review is the remarkable convergence between international and Indian evidence, suggesting that reproductive health awareness challenges among tribal populations are not isolated or region-specific but reflect broader structural and historical patterns. Across low- and middle-income countries (LMICs), high-income G20 nations, and India, tribal and Indigenous women consistently exhibit lower levels of comprehensive reproductive health knowledge and poorer engagement with services compared to non-Indigenous populations. 17 In both contexts, awareness of individual components, such as at least one modern contraceptive method or institutional delivery, is often present, yet this awareness frequently fails to translate into sustained health-seeking behaviour.19,20

Family Planning and Reproductive Autonomy

International and Indian studies alike highlight that family planning awareness among tribal women is often partial and fragmented. While knowledge of contraceptive methods may exist, understanding of correct use, side effects, and reproductive rights remains limited, constraining informed choice.22,23 Decision-making around contraception is frequently mediated by male partners, elders, or extended family members in both settings, limiting women’s reproductive autonomy. The persistence of these patterns across LMICs, G20 countries, and India suggests that patriarchal norms and collective decision-making structures are critical determinants of reproductive behaviour. Importantly, higher education and socioeconomic status consistently emerge as enabling factors, indicating that investments in female education and social empowerment may yield long-term gains in reproductive health outcomes. 22

Menstrual Health and Adolescent Reproductive Health

Menstrual health emerged as a consistently neglected area across both international and Indian studies. The evidence indicates that stigma, restrictive cultural norms, inadequate menstrual hygiene resources, and limited access to comprehensive sexuality education collectively contribute to poor reproductive health literacy among tribal and Indigenous adolescents. These barriers may increase vulnerability to early marriage, unintended pregnancy, and delayed health-seeking behaviour.32,44 The consistency of these findings across diverse contexts highlights the systemic marginalisation of adolescent SRHR, particularly among Indigenous and tribal populations.

Maternal and Child Health Awareness and Service Utilisation

Despite global improvements in maternal and child health (MCH) indicators, Indigenous populations continue to experience disproportionately poor outcomes. International and Indian evidence demonstrates limited awareness of comprehensive antenatal care components, delayed pregnancy registration, and inconsistent postnatal care utilisation.19,22

Importantly, disparities persist even in high-income countries with universal health coverage, such as Australia and Canada, underscoring that financial coverage alone does not guarantee equitable access or utilisation. 34 In India, although institutional delivery rates have improved, quality of care, continuity, and postnatal follow-up remain uneven, particularly in remote tribal regions. These findings reinforce the need to move beyond coverage metrics towards quality, cultural safety, and continuity of care. 40 Although most studies reported awareness deficits, a minority of studies identified relatively favourable service utilisation and maternal health awareness, suggesting that tribal populations are not homogeneous and that local health-system performance, education, and community engagement influence outcomes.19,47

Role of Traditional Beliefs and Cultural Practices

Traditional beliefs and cultural practices strongly influence reproductive health awareness and health-seeking behaviour among Indigenous populations. Preferences for home-based deliveries, reliance on traditional birth attendants, menstrual taboos, and restrictive gender norms often limit engagement with formal reproductive health services and education.19,43 Although traditional healers and Indigenous knowledge systems provide culturally meaningful support, exclusive reliance may delay timely referral to biomedical care. 22 Similar patterns are observed among tribal communities in India, where trust in dais and local healers, along with ritualised childbirth and postnatal practices, contributes to lower utilisation of maternal and child health services.12,45,46

Reproductive Health Schemes

The findings indicate moderate to high awareness of key maternity schemes such as JSY and JSSK among tribal women; however, incomplete understanding of entitlements and inconsistent utilisation persist. 47 Marked regional variation is observed in PMMVY and PMSMA uptake, influenced by socioeconomic and health system factors.48,49 Adolescent- and nutrition-focused schemes show wider coverage but uneven quality and continuity, reinforcing a persistent awareness–utilisation gap.9-11

Why Does Awareness Not Always Translate Into Utilisation?

One of the most consistent findings across the reviewed literature was the persistent awareness-utilisation gap. Although awareness of contraceptive methods, institutional delivery services, and government reproductive health schemes was often moderate to high, actual service utilisation remained inconsistent. This suggests that awareness alone is insufficient to influence reproductive health behaviours. Multiple interacting barriers contribute to this gap. At the individual level, misconceptions regarding contraception, fear of side effects, and low reproductive autonomy limit decision-making. At the household level, patriarchal norms and dependence on husbands or elders constrain women’s choices. At the community level, menstrual stigma, traditional beliefs, and social expectations discourage engagement with formal health services. At the health-system level, geographic isolation, transportation barriers, shortages of healthcare personnel, and culturally insensitive service delivery further impede utilisation.

Which Barriers Are Most Modifiable?

Although some determinants, such as geographic remoteness, are difficult to modify in the short term, several barriers are amenable to intervention. These include inadequate reproductive health literacy, weak adolescent-friendly services, poor frontline health worker communication, limited male involvement, and insufficient culturally tailored health education. Strengthening community-based health promotion, expanding digital and mHealth approaches, and improving provider cultural competence may offer practical and scalable solutions.

Lessons From International Indigenous Health Models

Several international Indigenous health programmes provide valuable lessons for India. Indigenous-led healthcare services in Australia and Canada emphasise culturally safe care, community participation, and Indigenous workforce representation. Community health worker models in Latin America and participatory health promotion initiatives in New Zealand have demonstrated improvements in trust, service uptake, and health literacy. Adapting these approaches within India’s tribal health programmes could enhance the effectiveness of reproductive health awareness interventions and strengthen community ownership of health initiatives. Therefore, improving reproductive health outcomes among tribal and Indigenous populations requires interventions that address both awareness and structural barriers simultaneously. Gaps and challenges of Reproductive Health Awareness among Tribal/Indigenous Women and Adolescent Girls: International and Indian Contexts are presented in Table 1 below.

Table 1.

Gaps and Challenges of Reproductive Health Awareness Among Tribal/Indigenous Women and Adolescent Girls: International and Indian Contexts

Domain International evidence Indian evidence
Overall Sexual Reproductive Health awareness Consistently lower among Indigenous populations than non-Indigenous populations Lower among tribal women compared to the general population
Family planning awareness Contraceptive awareness generally high (60-95%), but utilisation lower (25-70%). Decision-making often influenced by partners and community norms. Awareness ranged from 55-90%, while utilisation remained lower (20-60%). Gender norms and sociocultural barriers limited reproductive autonomy.
Adolescent SRH & menstrual health Menstrual stigma, inadequate hygiene resources, limited sexuality education, and poor SRHR literacy among adolescents. Hygienic absorbent use ranged from 30-75%. Restrictive menstrual practices, poor menstrual hygiene management, inadequate sexuality education, and low SRHR literacy. Hygienic absorbent use ranged from 18-68%.
Maternal health awareness and Child health immunisation Lower awareness and utilisation of ANC, institutional delivery, postnatal care, immunisation, and infant-feeding services compared with non-Indigenous populations. Institutional delivery rates have improved, but ANC completion, postnatal care utilisation, and child health awareness remain inconsistent across tribal regions.
Traditional beliefs Reliance on traditional healers, menstrual taboos, and preference for home births influence reproductive health behaviours. Similar dependence on traditional healers and culturally embedded pregnancy, childbirth, and postnatal practices.
Awareness and utilisation of reproductive health programmes Targeted reproductive and maternal health programmes exist, but uptake remains constrained by structural and cultural barriers. Awareness of schemes such as JSY, JSSK, and PMMVY is generally moderate to high; however, utilisation remains variable, indicating an awareness-utilisation gap.
Major determinants and promising approaches Geographic isolation, language barriers, poverty, and culturally unsafe care contribute to inequities. Community health workers, Indigenous-led services, and mHealth interventions show promise. Low education, poverty, gender norms, remoteness, and health-system barriers affect awareness and utilisation. ASHAs, SHGs, community outreach, and digital health initiatives demonstrate potential for improvement.
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Study Limitations

This review has several limitations. First, as a narrative review, it did not include a formal risk-of-bias assessment or quantitative meta-analysis. Second, only English-language literature was included, potentially excluding relevant studies published in local languages. Third, heterogeneity in study designs, populations, and outcome measures limited direct comparison across studies. Fourth, several included policy documents and grey literature sources may not have undergone peer review. Finally, evidence from some tribal populations and geographic regions remains sparse, highlighting important research gaps. The review also did not undertake formal quality appraisal or risk-of-bias assessment of included studies. Consequently, findings should be interpreted as a narrative synthesis rather than weighted evidence based on methodological quality.

Recommendations

It is framed around the WHO Health System Building Blocks and Mapped Strategies for Tribal Reproductive Health. 50 Details are mentioned in Table 2: Mapping of programmatic strategies to the WHO health system building blocks below.

Table 2.

Mapping of Programmatic Strategies to WHO Health System Building Blocks 50

WHO building block Strategy Evidence source
Service Delivery Develop culturally sensitive, adolescent-friendly SRHR services in tribal areas. Studies reported limited SRHR awareness, menstrual stigma, and poor access to adolescent-friendly services among Indigenous and tribal adolescents.17,21,34,37
Integrate menstrual health education, family planning counselling, and maternal health services within primary care platforms. Menstrual health knowledge gaps, inadequate contraceptive counselling, and fragmented maternal health awareness were identified across settings.16,17,21,28,35,36
Strengthen outreach through mobile health clinics and village health and nutrition days (VHNDs). Geographic isolation and poor access to reproductive health services were identified as major barriers in tribal and Indigenous communities.19,20,22,25,39,40
Health Workforce Train ASHAs, ANMs, AWWs, and frontline workers in culturally competent and gender-sensitive reproductive health communication. Studies highlighted language barriers, culturally incongruent care, and the need for improved provider communication.5,16,17,26
Engage peer educators, SHG members, and tribal women leaders as community health facilitators. Community participation and peer-led approaches improved reproductive health awareness and service uptake among Indigenous populations.17,34,46
Build the capacity of providers in respectful maternity care and adolescent-friendly service delivery. Evidence showed mistrust of health systems, poor adolescent engagement, and barriers to maternal health service utilisation.5,27,34,39
Health Information Systems Use disaggregated data (tribe, age, gender, geography) to monitor reproductive health awareness and service utilisation. Ethnic inequalities in reproductive and maternal health indicators were demonstrated across multiple studies.18,19,24,25
Incorporate participatory and community-based monitoring mechanisms. Indigenous and tribal health programmes showed improved outcomes when communities participated in planning and monitoring.4,12,25
Leverage mHealth tools for health education, reminders, and real-time tracking of ANC, PNC, and scheme utilisation. Digital and community-based information systems were recommended to improve awareness and continuity of care in underserved populations.27,42
Access to Essential Medicines and Technologies Ensure uninterrupted availability of contraceptives, iron-folic acid tablets, sanitary products, and essential maternal health supplies at peripheral facilities. Limited access to contraceptives, menstrual products, and IFA supplementation was repeatedly reported.26,29,36,41
Promote low-literacy digital tools and mobile-based educational applications adapted for tribal contexts. Studies identified low health literacy and information barriers among tribal and Indigenous populations.16,17,34
Strengthen last-mile delivery systems in geographically remote tribal areas. Geographic remoteness and weak service availability were major determinants of poor utilisation.19,20,25,39
Health Financing Simplify access to reproductive health schemes (e.g., JSY, PMMVY) through decentralised, community-based enrollment and benefit disbursement. Awareness of schemes was often higher than utilisation due to administrative and access barriers.47-49
Prioritise equity-based resource allocation to high-burden tribal districts. Tribal populations consistently demonstrated poorer reproductive and maternal health indicators than national averages.19,24,25,39
Support community-led interventions through flexible funding mechanisms and performance-linked incentives. Community-based Indigenous health models improved service utilisation and health literacy.12,25,34
Leadership and Governance Institutionalise tribal-specific reproductive health policies and guidelines. Persistent tribal-specific inequities highlight the need for targeted policy responses.12,19,25
Foster intersectoral collaboration across health, education, women and child development, and tribal welfare departments. Menstrual health, adolescent SRHR, maternal health, and nutrition challenges were shown to be multidimensional and cross-sectoral.10,11,21,38
Promote community participation in planning, implementation, and accountability mechanisms to strengthen governance and trust. Indigenous-led health programmes in Australia, Canada, and Latin America demonstrated improved trust and service uptake through community ownership.4,25,27,34
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Conclusion

This narrative review systematically examined the scope and determinants of reproductive health awareness among tribal women and adolescent girls in India and internationally. The findings demonstrate that a complex interplay of socio-cultural norms, gender relations, education, socioeconomic status, geographic isolation, and health system responsiveness shapes awareness. Across both contexts, partial knowledge, persistent stigma, and reliance on traditional practices contribute to an awareness-utilisation gap, particularly in family planning, menstrual health, and maternal and child health services. The review also highlights variable awareness and uneven utilisation of major national reproductive health schemes in India, despite their wide coverage. These findings underscore the need for culturally sensitive, community-engaged, and adolescent-responsive interventions, strengthened frontline health systems, and improved scheme communication and continuity of care to enhance reproductive health awareness and equitable scheme implementation.

Implications of the Study

This review highlights persistent reproductive health awareness gaps among tribal and Indigenous women and adolescent girls despite the availability of multiple health programmes and services. The findings underscore the need for culturally sensitive, community-based, and adolescent-friendly reproductive health interventions that address both awareness and structural barriers to service utilisation. Strengthening frontline health worker capacity, improving health communication in local languages, enhancing community participation, and integrating reproductive health education within existing tribal health programmes may improve awareness and healthcare uptake. The review also provides evidence for policymakers to develop tribal-specific reproductive health strategies and supports future research on context-specific interventions to reduce reproductive health inequities among underserved populations.

Supplemental Material

Supplemental Material - Voices, Choices, and Access: A Narrative Review of Reproductive Health Awareness and Strategic Schemes in India and Beyond
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Supplemental Material for Voices, Choices, and Access: A Narrative Review of Reproductive Health Awareness and Strategic Schemes in India and Beyond by Rohit Raj, Jarina Begum, Syed Irfan Ali, Manasee Panda, Vani Lakshmi R, Takkella Nagamma in Health Services Insights.

Supplemental Material - Voices, Choices, and Access: A Narrative Review of Reproductive Health Awareness and Strategic Schemes in India and Beyond
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Supplemental Material for Voices, Choices, and Access: A Narrative Review of Reproductive Health Awareness and Strategic Schemes in India and Beyond by Rohit Raj, Jarina Begum, Syed Irfan Ali, Manasee Panda, Vani Lakshmi R, Takkella Nagamma in Health Services Insights.

Author Contributions: Rohit Raj: Conceptualization, Data curation, Investigation, Formal analysis, Methodology, Validation, Visualization, Writing-original draft. Jarina Begum: Conceptualization, Data curation, Investigation, Formal analysis, Methodology, Supervision, Validation, Writing review & editing. Syed Irfan Ali: Conceptualization, Formal analysis, Investigation, Methodology, Project administration, Supervision, Validation, Visualization, Writing-review & editing. Manasee Panda: Conceptualization, Investigation, Methodology, Supervision, Validation, Visualization, Writing-review & editing. Vani Lakshmi R: Conceptualization, Investigation, Methodology, Supervision, Validation, Visualization, Writing-review & editing. Nagamma Takkella: Conceptualization, Investigation, Methodology, Supervision, Validation, Visualization, Writing-review & editing.

Funding: The authors received no financial support for the research, authorship, and/or publication of this article.

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Supplemental Material: Supplemental material for this article is available online.

ORCID iDs

Rohit Raj https://orcid.org/0000-0003-0913-7073

Jarina Begum https://orcid.org/0000-0001-6884-6799

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Supplementary Materials

Supplemental Material - Voices, Choices, and Access: A Narrative Review of Reproductive Health Awareness and Strategic Schemes in India and Beyond
sj-pdf-1-his-10.1177_11786329261471746.pdf (207.7KB, pdf)

Supplemental Material for Voices, Choices, and Access: A Narrative Review of Reproductive Health Awareness and Strategic Schemes in India and Beyond by Rohit Raj, Jarina Begum, Syed Irfan Ali, Manasee Panda, Vani Lakshmi R, Takkella Nagamma in Health Services Insights.

Supplemental Material - Voices, Choices, and Access: A Narrative Review of Reproductive Health Awareness and Strategic Schemes in India and Beyond
sj-pdf-2-his-10.1177_11786329261471746.pdf (331KB, pdf)

Supplemental Material for Voices, Choices, and Access: A Narrative Review of Reproductive Health Awareness and Strategic Schemes in India and Beyond by Rohit Raj, Jarina Begum, Syed Irfan Ali, Manasee Panda, Vani Lakshmi R, Takkella Nagamma in Health Services Insights.

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