Academic journal article Journal of Health Population and Nutrition

Social and Logistical Barriers to the Use of Reversible Contraception among Women in a Rural Indian Village

Academic journal article Journal of Health Population and Nutrition

Social and Logistical Barriers to the Use of Reversible Contraception among Women in a Rural Indian Village

Article excerpt


Female sterilization is the most prevalent form of contraception in India, accounting for 76% of all use among women (1). Use rates of temporary modern contraceptive methods are very low. Previous studies have identified barriers to contraceptive use, which include the monetary and time costs of obtaining contraception (2,3), the social stigma of using contraceptives in an unsupportive setting (4,5), lack of knowledge (6,7), desire for more children (8- 10), the costs of acquiring additional information (11), and worry over possible side-effects and fears that reversible methods are ineffective (4,7,8,12). Historically, Indian health providers have emphasized female sterilization; this may also limit the uptake of reversible contraception (8,12,13).

This paper explores beliefs of women regarding reversible contraception in a context where women are able to achieve their fertility goals using sterilization and periodic abstinence with abortion as a back-up method (14). The study was conducted in a rural Indian village where stigma regarding sexual immoderation and myths and misconceptions regarding side-effects of reversible contraception and vasectomy also contribute to the conviction of women that sterilization is superior. Unlike many other rural areas, the study area women had access to modern methods from a health clinic, a hospital, and pharmacies nearby. A greater understanding of the contraceptive decision-making process has the potential to inform programmes that seek to increase the uptake of temporary contraceptive methods in rural India.

An estimated 75% of all contraceptive users (84% of those who use a modern contraceptive method) in India rely on female sterilization, while vasectomy is used by just 2% of contracepting couples (10). For many women, female sterilization is the first and the only contraceptive method they use (15). The median age at sterilization is 25.7 years; this, however, varies from a low of 23.6 years in Andhra Pradesh in southern India to 30.5 years in Manipur in eastern India (16). In 2001, an estimated 15.8% of currently-married Indian women of reproductive age had an unmet need for contraception, i.e. they desired to space or limit pregnancies but were not using contraceptive methods to do so (7). The contraceptive prevalence rate of reversible methods has remained low; while supplies of reversible contraceptives are available free of charge to women in some areas, demand has been weak (12). In Maharashtra, although 60.9% of women are using contraception, only 7.6% are using reversible methods for spacing (17). Birth intervals of <36 months, which have been linked to increased maternal and child morbidity and mortality (18-22), are more common among women who do not use spacing methods. However, provision of free contraception and monetary incentives for their use had limited success in India (23).


The study village (population ~2000) is located on the Konkan Coast of Maharashtra state, India, and is sub-divided into smaller hamlets divided along family and caste lines. Two of the hamlets are reachable by kanccha (paved) road, and the rest are accessible by packed earth roads. No public transport is available in the village. Each hamlet has a nursery school for young children. The village has a primary school for children, but the nearest high school is in a town seven km distant.

Virtually, all adult men migrate to Pune and Mumbai for work; those who remain engage themselves in farming. Oral contraceptive pills, intrauterine devices (IUDs), and condoms are available from a nearby (3 km) health post, pharmacies in the nearest town (7 km), and the taluka (district) capital (20 km), although access to these sources may be limited by the lack of public transport. Sterilization procedures for both men and women and abortion services are available only at the hospital in the taluka capital.

All the ever-married village women were informed of the study in the spring of 2005 during a villagelevel household census conducted by a local nongovernmental organization. …

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