Contraception and its access in India: Observations and Suggestions
As discussed in part 1 of this series, we discovered that cultural factors play a significant role in how women access contraception in India. In the field, the observations coincide with the statistical findings. In what way? We shall discuss it in this blog.
Quality Counselling by Service Providers and Front-line Workers
Service providers and front-line workers are pivotal in promoting and facilitating family planning, ensuring women and the community access comprehensive and unbiased information and services. One crucial aspect of their role is counseling and empowering women to make informed choices about their reproductive health. But it’s crucial to understand that provider bias, which includes women’s age, parity status, husband’s approval, and marital status, can be a significant barrier to women using their preferred contraceptive methods.
Biased attitudes and beliefs often result in judgmental, non-empathetic counselling which not only leads to overlooking what the woman wants but also involves favoring certain methods while discouraging others in the lack of a valid medical justification. Provider bias, moral judgments, personal myths, and misconceptions may limit the use of an expanded basket of contraceptive choices, hinder access to the most suitable family planning options, discourage future contraceptive care, and limit the contraceptive decision-making power or authority to a few of the prominent outcomes. The provider bias can be minimized by going beyond the traditional training and guidelines to more fundamental behavior and attitude change efforts through value clarification. Further, the providers should be trained to provide non-judgmental counselling rather than conventional counselling.
Moreover, the introduction of new contraceptive methods in family planning baskets has always been marred by controversies surrounding their efficacy, side effects, and safety. Consistent efforts need to be made to educate the service providers in every aspect of a newly introduced method to strengthen their capacities. They can provide more informed choices to women. In addition, providers need to clarify the prevalent myths and misconceptions associated with existing methods around side effects like bleeding, irregular periods, health concerns, etc. to add new women to the pool and parallelly keep the women motivated to continue using the contraceptive method.
The capacity building of each service provider and front-line worker can be significant in reaching the last mile. Their training must be technical and beyond; there needs to be greater emphasis on community mobilization and counseling for contraceptive methods and addressing myths and misconceptions prevailing in the communities regarding modern methods.
Expanding the basket without addressing the challenges will not solve the problem. While improving availability and accessibility to an expanded basket of contraceptives is a welcome step, it may not be enough to enable young people, especially women, to have a say in their reproductive health decision-making. In addition, coercive contraceptive choices subjected women to disable their reproductive autonomy. It is also imperative to understand that the services cannot be provided without competent and unbiased service providers and frontline workers.
We argue that contraceptive behaviors and women’s health is about women’s agency, choice and quality of reproductive health services. A comprehensive approach that addresses these factors alongside providing a wider range of options will better serve women’s reproductive health and autonomy.
Aayushi Rastogi – Senior Manager, Sambodhi
Shristy – Deputy Manager, Sambodhi
