What is Tokophobia, or the intense fear of childbirth?

In India, motherhood is glorified and worshipped like no other profession. The tendency to idealise the self-sacrificing nature of motherhood has resulted in mothers being praised in words while neglecting to acknowledge that they are human beings with their own needs, just like everyone else in the family.

However, little do we know that breaking traditional societal norms, the percentage of married women who don't want children, across regions and demographic groups, is on a steady rise. The percentage of childless women in our country increased from a mere 7 percent in 2015-2016 to 12 percent in 2019-2021, a Researchgate study suggested.

The proportion of currently married women who do not want any more children increases with age, a study by the Indian Express revealed. Only 25 per cent of currently married women in the age group (15-24) want no more children, compared with 66 per cent in the age group 25-34 years and 89 per cent in the age group of 35-49. Nearly 72 per cent of Sikh and 71 percent of Hindu currently married women aged 15-49 want no more children, compared with 64 percent of Muslim currently married women, the study showed.

What is Tokophobia? However, what is important to note is that, besides factors like rise in female schooling, age at marriage, and media exposure contributing to the spike in this phenomenon, Tokophobia or the intense fear of childbirth is gaining traction as a large number of women now openly speak about their mental health struggles related to pregnancy.

While many women look forward to pregnancy and motherhood, a growing number experience overwhelming anxiety and fear about childbirth, a condition known as tokophobia. This intense and often debilitating fear can prevent women from conceiving, lead to requests for cesarean deliveries, or even cause avoidance of sexual intimacy. In modern society, where conversations around mental health are evolving, tokophobia is slowly gaining the recognition it deserves.

Types: Tokophobia can be classified into two types, that is, primary tokophobia that impacts women who have never given birth and develop an extreme fear of the experience, sometimes from a young age, due to listening to traumatic stories or witnessing difficult births. Dr Sweta Lalgudi, Gynecologist, Zynova Shalby Hospital, Mumbai, said, “Secondary tokophobia is often seen due to a traumatic childbirth experience in the past. Both can severely impact a woman’s physical and emotional well-being, decision-making, and overall reproductive journey. Women will be in constant stress and fear.”

Impacts: Speaking about how women with tokophobia often suffer in silence due to the societal expectation that childbirth is a natural, even beautiful, experience, Dr Shorouq Motwani, Psychiatrist, Lilavati Hospital, Mumbai, said that this fear could cause constant distress, lead to depression or anxiety, and strain personal relationships. “Some women may choose to remain childfree or delay pregnancy indefinitely, while others opt for elective C-sections to avoid labor pain. Tokophobia is considered a taboo subject in India, and a large number of women avoid discussing it openly with their family or doctor. They feel shameful, embarrassed, and struggle in silence. It can be dismissed and is labeled as weak or overreacting, which discourages women from expressing their fears openly,” he added.

Speaking about the effects of Tokophobia, Rima Bhandekar, Senior Psychologist at Mpower Helpline, said that several women feel ashamed of their fears and feel completely disconnected from others. “In our society, mothers are often advised to simply bear with it, which does nothing to reduce their fear. Well-meaning statements like “You’ll be okay. Everyone goes through it,” from friends, family, or even medical professionals, only adds to the loneliness felt by such women. For the unversed, Tokophobia isn't a weakness. It’s a valid emotional and psychological response,” she added.

The fear element: Speaking about the level and extent of fear, Juslin Jacob, psychologist at Mpower Helpline, said that multiple studies show more than half of the participants reported feeling intense anxiety during their pregnancies, with about a third experiencing severe fear. “Common issues included sleepless nights, panic attacks, and requests for caesarean sections to avoid the stress of labor(Bhardwaj et al., 2024). This fear extends beyond just concerns about pain(Johnson et al., 2019); it encompasses worries about the baby’s health, the challenges of parenting, and past traumatic birth experiences (Sharma et al., 2022). Alarmingly, even women who have given birth before are not exempt from these feelings(Ramalingappa et al., 2022)."

Solutions: Experts also opined that on several occasions, doctors and even therapists dismiss tokophobia as hormones or nerves. Healthcare providers need better training on how to recognize tokophobia. Thankfully, the silence around tokophobia is finally chipping away. More women are voicing out their fears, especially online, sharing real, unfiltered stories. Some doctors and midwives are beginning to listen, offering support like providing balanced childbirth education, support groups, therapy, and trauma-informed care models that can help women express their fears in a safe, supportive environment.

Thane-based psychiatrist, Dr Sailesh Umate said medication like Selective Serotonin Reuptake Inhibitor (SSRI) is needed to deal with such cases.
Modes of counseling in these cases include:

1. Cognitive Behavioral Therapy (CBT)

2. Imagery

3. Role playing

4. Relaxation therapy

5. Exposure and response prevention.

6. Desensitisation

Dr. S A idress, Consultant - Psychiatrist, Manipal Hospital, Bhubaneswar, said that Tokophobia does not make someone weak. "It does not mean they are not meant to be a mother. It means they are afraid, and that fear is asking to be seen and understood. Healing begins with listening, creating space for honest conversations, offering therapy, support groups, gentle counseling, and families and doctors recognizing that this is not a drama or excuse. It is a valid emotional struggle. Every woman deserves the right to choose motherhood on her terms, with support, not shame. She should not be forced, rushed, or made to feel guilty for what she feels," he added. 

Speaking about medications, Dr. N Sapna Lulla, Lead Consultant - Obstetrics & Gynaecology, Aster CMI Hospital, Bangalore, said that Tokophobia is treatable. "Support from empathetic healthcare providers, access to therapy, and open conversations can make a difference. Cognitive-behavioral therapy (CBT), trauma-informed counseling, and birth education tailored with compassion have helped many women support their decision-making and find peace, whether they choose to become mothers or not," he added. 

Mathrubhumi spoke to a few women who shared their fear of childbirth.

Ruchika Aggarwal (Single, 32 years old): The violence of the process of childbirth is something that never appealed to me. It’s extremely life-threatening with physical ramifications that last forever. I personally do not think it’s fair that I need to go through unimaginable pain to bring life into this earth and then be told that the kid you labored to bring into this earth is not even going to get your name or carry your lineage. It is such a thankless job. Also, it conditions society to think that your body is nothing but an incubator. I rebuke it.

Rupsha SB (Married, 34 years old): I am pretty scared, mildly disgusted by the idea of growing a human inside me. It feels like raising a parasite. As a child, I liked kids, but as I grew up, they seemed more like a gigantic responsibility, and nothing more. I think around the end of school and early college, I started viewing kids as a liability.
Manasi Shinde (33, single): I’m so tired of the dismissal of real pain and trauma of childbirth. I do remember reading a couple of articles and social media stories on how little people know about childbirth, especially women. They are not equipped with proper knowledge before going into this. Isn’t it ridiculous that you get briefed about a thousand times when you need to get a minor surgery, but childbirth, which has historically been the biggest cause of death in women, is not seen as a major surgery or procedure? I have no interest in going through the process of childbirth and am very happy about it.
Sukriti Sharma (35 years old, married): Since my teenage years, I was well aware of the fact that I did not want to be a mother. By this, I mean I never wanted to conceive or give birth to another organism physically. I don’t find anything godly about the process, and thankfully, my peers and family members have been extremely supportive about my decision.