Barriers to use Contraceptive Methods among Rural Young Married Couples in Maharashtra, India: Qualitative Findings

Abstract

Introduction In rural India contraceptive use remains uncommon among newly married couples. non-use in rural young couples contributes to higher fertility rates. Objectives To identify barriers of spacing contraceptive use among young married couples in rural Maharashtra. Methods In-depth interviews were conducted with husbands (N=30), wives (N=20), and village health providers (N=12); additionally, 3 focus groups were conducted with mothers of husbands (N= 42 focused on understanding contraceptive use and barriers. Interviews and focus groups ranged in length from 90–120 minutes. Detailed notes taken during interviews were analysed using a grounded theory approach and the data was analysed using atlas-ti software. Results Major barriers to spacing contraception are: pro-natal social norms, pregnancy expectations early in marriage, to produce multiple sons, limited access to modern spacing contraceptives, family resistance to adopt contraceptives, lack of husband’s involvement on family planning issues, myths, misconceptions, perceived side effects and negative attitudes toward specific contraceptives. Conclusion Findings highlight the intersection of norms against spacing contraception, traditional gender ideologies and lack of male involvement as major barriers to the use of contraception. Male oriented outreach programmes on family planning. Promoting gender equity should be made through health programme deliveries with special focus in rural areas.

Cluster Randomized Controlled Trial Evaluation of a Gender Equity and Family Planning Intervention for Married Men and Couples in Rural India

“…Formative research involved qualitative data collection from rural couples, mothers-in-law, and providers serving rural couples. Findings demonstrated the need for FP education to dispel ongoing myths related to health consequences of spacing contraceptives and GE social norm change approaches related to expectations of pregnancy early in marriage, son preference, lack of male responsibility in FP, and greater male or in-law relative to female control of FP decision-making [ 24 ]. Although not published, this research also documented that males and females preferred not to engage mothers-in-law in the intervention process.…”

“…Increasing use of modern spacing contraceptives in the country requires improved demand for such contraception from both men and women, given that men often control contraceptive decision-making [ 5 – 13 ]. Male reproductive control of female partners, particularly in the context of intimate partner violence (IPV), can impede contraceptive use and increase risk for contraceptive failure, in India and globally [ 14 – 16 ]. Given men’s role in controlling contraception and, relatedly, the need to improve gender equity in this context (as demonstrated by disproportionate burden of IPV in the country [ 2 , 17 ]), engagement of men in FP interventions requires greater prioritization.…”

CHARM, a gender equity and family planning intervention for men and couples in rural India: protocol for the cluster randomized controlled trial evaluation

“…To inform development of protocols, research tools and training manuals for the CHARM Intervention, formative research was conducted in the form of in-depth interviews with rural young husbands ( n = 30), rural young wives ( n = 20), and health providers serving these populations ( n = 12, 8 private providers and 4 public health providers); and focus groups with mothers-in-law of rural young husbands ( n = 40 mothers, 4 groups, 8–14 individuals/group). In-depth interviews were used to capture more sensitive and personal information from participants, whereas focus group discussions were used to capture normative attitudes and behaviors within rural families [ 28 ]. This formative work was designed to offer comprehensive exploration of the cultural, social, psychological, and family norms and behaviors related to family planning and gender roles and ideologies within marriage from the perspective of rural young husbands, their wives and mothers, and public and private health providers.…”

Can a Gender Equity and Family Planning Intervention for Men Change Their Gender Ideology? Results from the CHARM Intervention in Rural India

“…Finally, the intervention addresses the structure of cathexis by discussing with men the role of mothers-in-law, parents, and other members of society in creating and enforcing family planning norms and using strategic discussions with men to challenge some of the norms that discourage equitable decision-making. Specific elements of the gender equity counseling were based on formative qualitative research and included normative expectations of pregnancy early in marriage, son preference, lack of male responsibility in family planning, and greater male control over family planning decision-making (Ghule et al 2015). For more information on the CHARM intervention components, see Table 1 and Yore et al (2016).…”