How empowered are women to choose contraception?

Abstract

Background: Current contraception rate is approximately 40% (2011) in India. This leaves more than 60% of the eligible couple not using any contraception. It might be owing to socioeconomic and cultural background. Targeting this group to find the reasons behind the refusal of contraception would help us to tailor further delivery of family planning services to work toward achieving the target replacement fertility rate of 2.1. Objective: To assess the uptake of contraception and the influence of social, economic, and cultural factors on the contraceptive practices of our patients. Materials and Methods: This was a prospective survey done at the Department of Obstetrics and Gynaecology of Cama & Albless Hospital, Mumbai, during the months of July/August 2015. Women (those with perinatal mortality or morbidity and maternal morbidity were excluded) who delivered at our hospital were asked about their preference of contraception. The social and economic background of these women was then recorded, as were their responses to contraceptive counseling. The reasons for those women not willing to undergo/undertake any form of contraception were also recorded and analyzed in our study. Result: The contraceptive uptake rate was 77%, while 23% women refused any form of contraception. Among those who accepted, tubal ligation was the most popular permanent method, and combined contraceptive pills and barrier methods ranked next in the temporary methods. Although 95% of women in both groups were unemployed, decision-making regarding contraception use was significantly different in the two groups. Although only 20% of women were allowed to solely decide on the choice of contraception in both groups, the accepted group showed a higher chance of joint decision-making with the husband and less interference from any other member in the family. Two common reasons for refusal were religious grounds and did not feel the necessity of contraception. Of 11 cases of refusal based on religious grounds, 10 were Muslims. Conclusion: Women in our study sample who refused contraception did not seem to be empowered with education, employment, awareness, or cultural independence. Identifying these factors should help us achieve the tailor further delivery of family planning services to work toward achieving the target replacement fertility rate of 2.1.