Understanding quality of contraceptive services from women’s perspectives in Gujarat, India: a focus group study

Abstract

ObjectivesUnderstanding quality of contraceptive care from clients’ perspectives is critical to ensuring acceptable and non-harmful services, yet little qualitative research has been dedicated to this topic. India’s history of using incentives to promote contraceptive use, combined with reports of unsafe conditions in sterilisation camps, make a focus on quality important. The study objective was to understand women’s experiences with and preferences for contraceptive counselling and care in the public sector in India.DesignQualitative study using eight focus group discussions (FGDs). FGDs were thematically analysed using a framework approach.SettingRural and urban areas in one district in Gujarat.Participants31 sterilisation and 42 reversible contraceptive users who were married and represented different backgrounds. Inclusion criteria were: (1) female, (2) at least 18 years and (3) receipt of contraception services in the last 6 months from public health services.ResultsProviders motivate married women to use contraception and guide women to specific methods based on how many children they have. Participants found this common practice acceptable. Participants also discussed the lack of counselling about reversible and permanent options and expressed a need for more information on side effects of reversible methods. There were mixed opinions about whether compensation received for accepting long-term methods affects contraceptive decision making. While many women were satisfied with their experiences, we identified minor themes related to provider coercion towards provider-controlled methods and disrespectful and abusive treatment during sterilisation care, both of which require concerted efforts to address systemic factors enabling such experiences.ConclusionsFindings illuminate opportunities for quality improvement as we identified several gaps between how women experience contraceptive care and their preferences, and with ideals of quality and rights frameworks. Findings informed adaptation of the Quality of Contraceptive Counselling Scale for India, and have implications for centring quality and rights in global efforts.

Perceptions of family planning among married women aged 18 to 49 years and healthcare providers in Raipur, India: A qualitative study

“…Certain believes and myths(such as intake of oblation can prevent pregnancy), cultural practices, religious in uences(especially in Muslim community), pregnancy expectation early in marriage, fear of perceived side-effects(especially for IUCD), denial for female sterilization due to health conditions were some of the barriers to contraceptive use. Similar reasons were quoted by prior research, indicating that these barriers have not changed over time (11) (12) (13)(15)(16). Interestingly, the side-effects reported which in uenced women's utilization of any type of contraceptive were based on rumours and hearsay, rather than personal experience (14) (15).…”

Balancing client preferences and population-level goals: a qualitative study of the ways in which public health providers and facility administrators interpret and incentivise quality of care in contraceptive counselling in Ethiopia, Mexico and India

“…While the Indian providers included in our dataset did not outwardly indicate a preference for LARCs, instead reporting that they recommend particular methods based on a woman’s life stage, research conducted with family planning clients in India under the auspices of the QCC study indicates a more complex picture. Some women in this study experienced coercion related to provider-controlled methods of contraception, suggesting that providers may be pushing these methods in practice more than they indicated in our interviews 46 .…”

“…Finally, we were unable to member-check our findings and we have not included the client perspective in this analysis. However, findings from client interviews conducted under the purview of the QCC study in Ethiopia and India are published elsewhere 46 , 47 and we draw on these earlier findings to enhance our own in the Discussion.…”

Adaptation and validation of the quality of contraceptive counseling (QCC) scale for use in Ethiopia and India

“…Each country's study team made a small set of initial modifications to the originally validated QCC items from Mexico to reflect the local context and women's preferences for contraceptive counseling identified in earlier formative work conducted for the purpose of QCC scale adaptation [12,13], and translated the items into Amharic (Ethiopia) and Gujarati (India). We then conducted cognitive interviews with 20 women in each country to ensure that the scale items were relevant and comprehensible (recruitment approach and eligibility criteria for cognitive interviews was the same as that detailed below for the client exit interview surveys fielded to quantitatively validate the scale).…”

“…The QCC-Mexico Scale was originally developed and validated in two states in Mexico. As a first step toward adapting the scale for use in other settings, our team conducted focus group studies with contraceptive clients in Ethiopia and India to understand women's expressed preferences for counseling in these settings [12,13]. In this manuscript, we report on the adaptation of QCC scale items and findings from a survey study conducted for the purpose of testing the validity and reliability of the revised QCC Scales (QCC-India and QCC-Ethiopia) for use in quality and rights monitoring in both countries.…”