About a year and a half ago, in a small village in Dholpur district, I came across a wedding celebration. Wanting to congratulate the soon-to-be bride, I stepped into the mehendi celebration. Out of curiosity, I asked the girl her age, and she promptly replied, “Eighteen years.” There was an air of silence, her mother and relatives seemed nervous. I congratulated her and the family. My experience and understanding of cultural norms told me she was certainly younger than 18 years. Barely a year later, she was pregnant with her first child. When I gently asked if she had planned the pregnancy, she looked at me nervously. That awkward silence said everything.Working with the Jagan Foundation in eastern Rajasthan, I have heard too many stories like hers. The names and faces change, but the pattern remains painfully familiar: girls from poor and marginalised families had almost no real say in when they marry, whether they use contraception or when they start planning a family.The NFHS-6 data, released recently, only confirms what we have been seeing on the ground. Beneath all the government talk of improving maternal health and falling fertility rates, a troubling picture is emerging — especially in Rajasthan.Rajasthan’s disturbing trendAccording to NFHS-6, the percentage of girls aged 15-19 in Rajasthan who were already mothers or pregnant at the time of the survey has gone up from 3.7% in NFHS-5 to 4.7%. At the same time, modern contraceptive use among married women has fallen from 62.1% to 57.1%. Interestingly, overall contraceptive use increased slightly, but that rise came largely from greater reliance on traditional methods.This decline is particularly significant because it comes at a time when Rajasthan’s fertility rate has stabilised, suggesting that many couples may be trying to avoid pregnancies without access to reliable modern methods.Nationally too, modern contraceptive prevalence has slipped, while dependence on less reliable traditional methods has increased. These are not just dry numbers. They point to something worrying: despite years of schemes and campaigns, young girls in many parts of the country are still being pushed into early motherhood.Why are teenage pregnancies rising?The rise in adolescent pregnancies is particularly striking because it comes at a time when Rajasthan has reported improvements in girls’ education, declining fertility rates and a gradual reduction in child marriage. The trend suggests that marriage alone does not explain early motherhood.Public health experts increasingly point to gaps in adolescent reproductive health services and counselling. While programmes such as the Rashtriya Kishor Swasthya Karyakram (RKSK) were designed to provide adolescent-friendly health services, their reach and visibility remain uneven, particularly in rural areas. Many girls have limited access to confidential counselling on reproductive health, contraception and family planning.In the communities where I work, marriage is often followed by immediate pressure to have a child. Newly married girls frequently describe expectations from husbands, mothers-in-law and extended families to prove their fertility soon after marriage. Even where awareness exists, the social space to delay pregnancy is often missing.As a result, adolescent motherhood continues to persist despite improvements in other development indicators.Sunita Devi (name changed), an ASHA worker in Dholpur district, says the challenge is rarely a lack of awareness alone. “In my village, currently there are two pregnant girls who around 16-17 years old. Most girls know that having a child immediately after marriage is difficult, but very few are in a position to say no. Often, the pressure comes from within the family. Mothers-in-law want a grandchild quickly, and many husbands are reluctant to discuss contraception,” she says.According to her, frontline health workers frequently find themselves negotiating not with young women but with entire families.“We counsel girls, but the final decision is usually taken by someone else,” she says.I have often seen newly married girls attend health camps or community meetings but remain silent when conversations turn to contraception. Later, when spoken to privately, many admit they would prefer to delay their first pregnancy but feel unable to challenge family expectations. The gap between awareness and decision-making remains one of the least discussed barriers in reproductive health.The problem runs deeper than awareness campaigns alone.Inequality shapes reproductive outcomesIn tribal and remote districts, weaker health infrastructure, lower female literacy levels, limited mobility and economic vulnerability often combine to restrict reproductive choices.The overlap of poverty, low education and rigid social norms creates a perfect storm. Often for young girls, marriage and motherhood often come as a package deal, whether the girl is ready or not.This is why teenage pregnancy cannot be viewed solely as a health issue. It is also linked to poverty, education, social exclusion and gender inequality. In many of the villages where I work, the girls most likely to become mothers during adolescence are often the same girls who leave school early, have limited mobility outside their homes and come from families struggling with poverty. The inequalities visible in reproductive health are often the same inequalities visible in education, nutrition and employment.Public health expert Chhaya Pancholi argues that the persistence of teenage pregnancy among vulnerable groups reflects deeper structural inequalities. “When a girl becomes pregnant in adolescence, it is rarely an isolated event. It is usually the outcome of multiple disadvantages — poverty, interrupted education, early marriage, limited mobility and weak access to reproductive health services. That is why teenage pregnancy must be viewed not only as a health concern but also as a development and social justice issue,” she says. Pancholi adds that while India has improved maternal health outcomes substantially over the last two decades, progress has been uneven. “The girls most likely to become adolescent mothers are often the same girls who are least likely to complete school, access quality healthcare or participate in decisions affecting their own lives,” she saysThe consequences are harsh and long-lasting. Adolescent mothers face greater risks of anaemia, complications during delivery and delivering underweight babies. Many drop out of school permanently, ending whatever chance they had at a better life. This, in turn, affects their children, who often start life at a disadvantage.For a state like Rajasthan, which is trying hard to improve its development indicators, this rise in teenage pregnancies is a serious setback — affecting education, health, women’s workforce participation and the much-talked-about demographic dividend.Beyond service delivery: The question of agencyFor years, the Rajasthan government has measured success in maternal and child health through indicators such as institutional deliveries, antenatal care coverage and overall fertility reduction. Schemes such as Mukhyamantri Rajshri Yojana, Beti Bachao Beti Padhao and the State Strategy and Action Plan for Prevention of Child Marriage have contributed to visible progress on paper.The real challenge now is not just ensuring girls survive pregnancy, but ensuring they have the information, support and autonomy to delay it. Are adolescent girls receiving reproductive and sexual health counselling under RKSK? Are schools effectively implementing age-appropriate health education? Are frontline workers adequately trained and supported to engage with families on delaying marriage and first pregnancies?Over the years, I have seen health centres improve, institutional deliveries increase and frontline workers become more active in villages. These are important gains. Yet many adolescent girls still have little say in when they marry or when they have their first child.What needs to changeNFHS-6 should force us to look beyond rosy press releases. Keeping girls in school, delaying marriage, creating better livelihood opportunities and making health services truly adolescent-friendly are all important. But none of this will work unless we seriously challenge the deep-rooted social norms that continue to define a girl’s worth through marriage and motherhood.We also need to bring men into the conversation on family planning instead of placing the entire physical, emotional and social burden on women.For a middle-class girl in a city, an early pregnancy might mean a delayed career. For the girls I meet in Dholpur and surrounding areas, it often means the end of dreams of becoming a teacher, a nurse or simply living with dignity and independence.The challenge today is not only to ensure that women survive pregnancy and childbirth. It is to ensure that girls and women can participate in decisions about their own futures. In the communities where I work, many young women know what they want from life. What they often lack is the power to make those choices a reality.The 16-year-old girl I met in Dholpur will probably never read NFHS-6. She may never know that policymakers are debating fertility rates, contraceptive prevalence or adolescent health indicators. What she does know is that some of the most important decisions in her life were made before she had a chance to make them herself.Whenever I meet adolescent girls through our work, I am struck by how similar their aspirations are. They want to study, earn an income, support their families and build independent lives. Very few tell me that they dream of becoming mothers at 16.Until girls like them can decide when to marry, when to become mothers and whether to have children at all, India’s reproductive health story will remain incomplete. NFHS-6 is not merely a health survey. It is a reminder that reproductive choice, like education and economic opportunity, remains deeply unequal – and that women-led development cannot be achieved without women-led decisions.Malvika Mudgal is a social entrepreneur and founder of Jagan Foundation, working on women’s health, education and grassroots development in Rajasthan’s Chambal region.