Reproductive health in India exists at the crossroads of policy shifts, structural inequities, and historical legacies of population control. While the state has moved from coercive demographic targets to a rights-based language post-International Conference on Population and Development (1994), implementation remains fraught with exclusions. This paper examines the evolution of India’s reproductive health policies, revealing how caste, class, religion, gender, and geography continue to mediate access to services. Programs like Janani Suraksha Yojana and Mission Parivar Vikas have increased institutional deliveries and contraceptive use, yet deep-rooted biases persist. Global initiatives such as the WHO Safe Motherhood Initiative and United Nations Population Fund’s reproductive health programs have provided frameworks that India has adapted with varying degrees of success across different states. Female sterilization remains the dominant contraceptive method, raising concerns about informed consent, gendered burdens, and limited choice. Adolescent health, safe abortion access, and the inclusion of LGBTQ+ communities remain marginal in mainstream frameworks. The paper focuses on the voices of Dalit, Adivasi, Muslim, and queer populations to highlight how intersectional vulnerabilities are often ignored in the pursuit of numeric targets. Drawing on feminist and reproductive justice frameworks, it calls for a transformative approach that centers dignity, autonomy, and accountability. The paper argues that true reproductive freedom demands more than service coverage—it requires dismantling the socio-political structures that govern bodies, choices, and care. Public health, therefore, must be reimagined not merely as service provision but as a domain of rights, resistance, and radical inclusion.