Bahuguna Manjula, Das Sushmita, Shende Sushma, Manjrekar Shreya, Pantvaidya Shanti, Fernandez Armida, Jayaraman Anuja
SNEHA (Society for Nutrition, Education and Health Action), Mumbai, Maharashtra, India.
PLOS Glob Public Health. 2023 Mar 2;3(3):e0000634. doi: 10.1371/journal.pgph.0000634. eCollection 2023.
Rapid urbanization and a high unmet need for family planning in urban informal settlements point to the significance of identifying gaps that exist in the path of voluntary uptake of contraceptives. We undertook this study to better understand the perspectives related to family planning among women living in informal settlements of Mumbai. We used a mixed-methods approach, including a cross-sectional survey with 1407 married women of reproductive age and face-to-face in-depth interviews with 22 women, both users and non-users of modern contraceptives. 1070 (76%) of the participants were using modern contraceptives and women's age, education, parity, socioeconomic status and exposure to family planning interventions were the main determinants of contraceptive use. Poor contraceptive awareness before marriage coupled with social norms of early childbearing and completing family resulted in unplanned and less spaced pregnancies even among current users. In such cases, women either continued with the pregnancy or opted for abortion which sometimes could be unsafe. The decision to use contraceptives was taken in most cases after achieving the desired family size and was also influenced by belief in traditional methods, fear of side effects, spousal/family awareness and counselling by frontline workers. We recommend strengthening of sexual and reproductive health component of adolescent health programs. It is pertinent to inform women about their reproductive rights and most importantly empower them to practice these rights. This can be achieved by increasing women's age at marriage and continued promotion of formal education. Widespread misconceptions related to the side effects of modern methods need to be mitigated via counselling. Referral, follow-up, and suggestions on available choices of contraceptives should be given in case women face any side effects from the use of contraceptives. At the same time, improving spousal awareness and communication regarding family planning will allow couples to make informed decisions. Finally, roping in role models in the community will create an environment conducive to operationalizing rights-based family planning.
快速城市化以及城市非正式住区对计划生育的高未满足需求，表明了识别自愿采用避孕药具过程中存在的差距的重要性。我们开展这项研究是为了更好地了解孟买非正式住区女性对计划生育的看法。我们采用了混合方法，包括对1407名育龄已婚女性进行横断面调查，以及对22名女性（包括现代避孕药具使用者和非使用者）进行面对面深入访谈。1070名（76%）参与者正在使用现代避孕药具，女性的年龄、教育程度、子女数量、社会经济地位以及接触计划生育干预措施是避孕药具使用的主要决定因素。婚前对避孕的认知不足，再加上早育和生育完整家庭的社会规范，导致即使是当前使用者也会出现意外怀孕且生育间隔较短的情况。在这种情况下，女性要么继续妊娠，要么选择堕胎，而堕胎有时可能不安全。大多数情况下，在达到期望的家庭规模后才会做出使用避孕药具的决定，这也受到对传统方法的信仰、对副作用的恐惧、配偶/家人的认知以及一线工作人员的咨询的影响。我们建议加强青少年健康项目中的性与生殖健康部分。告知女性她们的生殖权利并赋予她们行使这些权利的权力非常重要。这可以通过提高女性结婚年龄和持续推广正规教育来实现。需要通过咨询来减轻与现代方法副作用相关的普遍误解。如果女性在使用避孕药具时出现任何副作用，应提供转诊、随访以及关于可用避孕选择的建议。同时，提高配偶对计划生育的认知和沟通，将使夫妻能够做出明智的决定。最后，引入社区榜样将营造一个有利于实施基于权利的计划生育的环境。
