Restrictions on contraceptive services for unmarried youth: a qualitative study of providers’ beliefs and attitudes in India

Abstract

Sexual and reproductive health (SRH) of unmarried youth is an important issue, particularly in Indian society, where premarital sex is socially restricted. It is an uncomfortable subject for most people, including healthcare providers, who are responsible for catering to the reproductive health needs of youth. This is because of the prevailing social norms, where sex outside marriage is discouraged and stigmatised. These social norms give importance to virginity, and children outside marriage are not welcome. The present qualitative study was conducted in public health facilities (primary and secondary) to explore the attitudes of healthcare providers in providing contraceptive services to unmarried youth. In-depth interviews were conducted with family planning (FP) service providers (frontline healthcare workers [ASHAs] nurses and FP counsellors) between October 2017 and September 2018. Almost a quarter of the providers were either hesitant or against providing contraceptives to unmarried youth. Providers stated that they preferred emergency contraceptive pills for unmarried girls if they had already engaged in unprotected sex. Providers expressed strong personal views against premarital sex because they believed it was against existing social norms. Some providers were concerned about the possible negative reactions of the community if they recommended any contraceptive to unmarried youth. A few providers even considered it illegal to provide contraceptives to unmarried youth, though there is no such law in the country. Findings further indicated that though the country had launched programmes for improving adolescents and youth SRH, service providers were still conflicted between medical eligibility and social beliefs.

Impact of a capacity-building intervention on views and perceptions of healthcare providers towards the provision of adolescent sexual and reproductive health services in southeast Nigeria: a cross-sectional qualitative study

“…In order to improve access to contraceptives among adolescents, healthcare providers support adolescents in making contraceptive choices that meet their SRH needs 33. In a recent qualitative study conducted in India37 and a Nigerian study,33 some healthcare providers highlighted that all categories of adolescents should have access to contraceptive services, and that information and services regarding contraceptives should be made readily available for both sexually active and non-sexually active adolescents 37…”

“…The capacity-building intervention showed positive parental and community support toward the provision of SRH counselling services to adolescents. The fear of community and parental reaction to the provision of SRH services for unmarried adolescents contributes immensely to the views and perceptions of healthcare providers towards the provision of SRH services such as contraceptive services to adolescents 37…”

“…33 In a recent qualitative study conducted in India 37 and a Nigerian study, 33 some healthcare providers highlighted that all categories of adolescents should have access to contraceptive services, and that information and services regarding contraceptives should be made readily available for both sexually active and non-sexually active adolescents. 37 Our finding that the informal healthcare providers have become more relaxed, bolder and more comfortable in delivering SRH services to adolescents corroborates Chandra-Mouli and colleagues' finding that to improve adolescents' access and use of SRH services, interventions should target building parent and community support. 26 The capacity-building intervention showed positive parental and community support toward the provision of SRH counselling services to adolescents.…”

“…The fear of community and parental reaction to the provision of SRH services for unmarried adolescents contributes immensely to the views and perceptions of healthcare providers towards the provision of SRH services such as contraceptive services to adolescents. 37 Interestingly, the informal healthcare providers believed that their capacity to deliver more adolescent-friendly SRH services following the capacity-building intervention enabled increased patronage by adolescent clients. For the formal providers, an inference was that the introduction of safe spaces, extracurricular activities and games following the SRH training of health providers improved SRH service utilisation among adolescent clients, which was similar to findings from a study in South Africa, where 89.4% of adolescent girls and young women reported that the safe spaces for delivering adolescents' SRH services offer a safe, quiet and comfortable environment when Open access accessing the SRH services.…”

Descriptive Study on a Nationwide Exploratory Questionnaire Survey of Emergency Contraceptive Pills and Their Sexual History and Knowledge in Japan

“…14,15) The use of ECPs was reported to be increasing during the pandemic. 16) Although some countries had negative attitudes towards the use of contraceptives by unmarried women due to cultural reasons, 17) the interest in ECPs was increasing day by day in Japan. As mentioned previously, the need to know the proportion of sexually active women in their reproductive age, and to understand the extent of their knowledge in topics relating to "sexual and reproductive health education" are important issues to be explored.…”