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For almost four decades, India focused on reducing fertility rates and promoting family planning. However, over the last decade, the focus has shifted to reducing health risks from early childbearing and poor birth spacing, through the National Health Mission (NHM). This report supports the NHM in improving its targeting of services to “high-priority districts” identified through the MPV initiative. Using the Annual Health Survey data from 2012-13, this descriptive and multiple regression analysis identifies factors that most affect fertility and contraceptive use in high-fertility districts. It also emphasizes the importance of addressing conditions that impact the desired family size.