Understanding drivers of family planning in rural northern India: An integrated mixed-methods approach.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2021
2021
Historique:
received:
10
07
2020
accepted:
28
11
2020
entrez:
13
1
2021
pubmed:
14
1
2021
medline:
27
4
2021
Statut:
epublish
Résumé
Family planning is a key means to achieving many of the Sustainable Development Goals. Around the world, governments and partners have prioritized investments to increase access to and uptake of family planning methods. In Uttar Pradesh, India, the government and its partners have made significant efforts to increase awareness, supply, and access to modern contraceptives. Despite progress, uptake remains stubbornly low. This calls for systematic research into understanding the 'why'-why people are or aren't using modern methods, what drives their decisions, and who influences them. We use a mixed-methods approach, analyzing three existing quantitative data sets to identify trends and geographic variation, gaps and contextual factors associated with family planning uptake and collecting new qualitative data through in-depth immersion interviews, journey mapping, and decision games to understand systemic and individual-level barriers to family planning use, household decision making patterns and community level barriers. We find that reasons for adoption of family planning are complex-while access and awareness are critical, they are not sufficient for increasing uptake of modern methods. Although awareness is necessary for uptake, we found a steep drop-off (59%) between high awareness of modern contraceptive methods and its intention to use, and an additional but smaller drop-off from intention to actual use (9%). While perceived access, age, education and other demographic variables partially predict modern contraceptive intention to use, the qualitative data shows that other behavioral drivers including household decision making dynamics, shame to obtain modern contraceptives, and high-risk perception around side-effects also contribute to low intention to use modern contraceptives. The data also reveals that strong norms and financial considerations by couples are the driving force behind the decision to use and when to use family planning methods. The finding stresses the need to shift focus towards building intention, in addition to ensuring access of trained staff, and commodities drugs and equipment, and building capacities of health care providers.
Sections du résumé
BACKGROUND
Family planning is a key means to achieving many of the Sustainable Development Goals. Around the world, governments and partners have prioritized investments to increase access to and uptake of family planning methods. In Uttar Pradesh, India, the government and its partners have made significant efforts to increase awareness, supply, and access to modern contraceptives. Despite progress, uptake remains stubbornly low. This calls for systematic research into understanding the 'why'-why people are or aren't using modern methods, what drives their decisions, and who influences them.
METHODS
We use a mixed-methods approach, analyzing three existing quantitative data sets to identify trends and geographic variation, gaps and contextual factors associated with family planning uptake and collecting new qualitative data through in-depth immersion interviews, journey mapping, and decision games to understand systemic and individual-level barriers to family planning use, household decision making patterns and community level barriers.
RESULTS
We find that reasons for adoption of family planning are complex-while access and awareness are critical, they are not sufficient for increasing uptake of modern methods. Although awareness is necessary for uptake, we found a steep drop-off (59%) between high awareness of modern contraceptive methods and its intention to use, and an additional but smaller drop-off from intention to actual use (9%). While perceived access, age, education and other demographic variables partially predict modern contraceptive intention to use, the qualitative data shows that other behavioral drivers including household decision making dynamics, shame to obtain modern contraceptives, and high-risk perception around side-effects also contribute to low intention to use modern contraceptives. The data also reveals that strong norms and financial considerations by couples are the driving force behind the decision to use and when to use family planning methods.
CONCLUSION
The finding stresses the need to shift focus towards building intention, in addition to ensuring access of trained staff, and commodities drugs and equipment, and building capacities of health care providers.
Identifiants
pubmed: 33439888
doi: 10.1371/journal.pone.0243854
pii: PONE-D-20-21461
pmc: PMC7806122
doi:
Substances chimiques
Contraceptive Agents
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0243854Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Cochrane Database Syst Rev. 2013 Apr 30;(4):CD006964
pubmed: 23633337
J Biosoc Sci. 2013 Nov;45(6):779-98
pubmed: 22958417
PLoS One. 2019 Apr 17;14(4):e0214922
pubmed: 30995274
Lancet. 2012 Jul 14;380(9837):111-25
pubmed: 22784531
BMJ Glob Health. 2020 Oct;5(10):
pubmed: 33028696
Science. 1974 Sep 27;185(4157):1124-31
pubmed: 17835457
Niger J Clin Pract. 2009 Sep;12(3):306-10
pubmed: 19803032
Stud Fam Plann. 2011 Jun;42(2):67-82
pubmed: 21834409
BMC Public Health. 2010 Aug 02;10:450
pubmed: 20673374
J Pers. 1994 Sep;62(3):281-98
pubmed: 7965560
Am J Obstet Gynecol. 2006 Jul;195(1):85-91
pubmed: 16626610
Asia Pac J Public Health. 2012 Nov;24(6):1002-12
pubmed: 21807625
PLoS One. 2016 May 11;11(5):e0153190
pubmed: 27167981
Indian J Med Res. 2018 Dec;148(Suppl):S1-S9
pubmed: 30964076
Gates Open Res. 2019 Mar 18;3:886
pubmed: 31294419
PLoS One. 2017 Jul 27;12(7):e0181411
pubmed: 28749979
Bull World Health Organ. 2010 Mar;88(3):227-31
pubmed: 20428392
Stud Fam Plann. 1999 Sep;30(3):193-211
pubmed: 10546311
Glob Health Sci Pract. 2016 Jun 27;4(2):191-210
pubmed: 27353614
Int Nurs Rev. 2009 Sep;56(3):340-5
pubmed: 19702808
Cult Health Sex. 2012;14(4):421-33
pubmed: 22390371
Reprod Health Matters. 2010 May;18(35):154-62
pubmed: 20541094
Cult Health Sex. 2015;17(9):1132-46
pubmed: 26032620