Getting a 360 Degree View on Family Planning Choices

The Challenge

Couples considering family planning face a variety of choices and a host of personal and systemic barriers in their decision-making process. As we seek to empower these men and women in their family planning decisions, we need to develop a more holistic understanding of their choices to help us offer more precise solutions to their challenges.

Our Approach

We collaborated with the Clinton Health Access Initiative and the government of Madhya Pradesh to conduct India’s most comprehensive survey on sexual and reproductive health in a decade. In Madhya Pradesh, we surveyed more than 15,300 married women, their husbands, and their community health workers to holistically explore all of the factors and people influencing family planning decisions.

Key Results

We are still evaluating data, but key findings so far include:

• Couples rarely use effective, temporary family planning methods despite high awareness. Intention to use effective and temporary methods is particularly low.
• Perceptions about safety and effectiveness influence use. Perceptions are largely driven by perceived side effects, such as abdominal pain or menstrual imbalance.
• Family planning decision making is largely spousal, with limited interaction with the health system.
• Family planning is considered an extremely difficult task by community health care workers, who also consider it a low priority compared to their other work.

To provide precision public health solutions in the area of family planning, we need to know what is driving these decisions from the perspective of couples. Only then can we design messages, interventions, and resources that help these men and women achieve their family planning goals.

In this comprehensive study, we focused on the “why” of sexual and reproductive health decisions. We wanted to know the reasons why a couple might choose a certain family planning method and the factors involved. We sought to understand the sources of information and influence, from family members to health care workers. We also recognized the importance of gathering more data regarding how if at all people are interacting with CHWs on family planning and if CHWs are effective on family planning counseling. 

 While the data is still under analysis, the early insights show limitations of any universal approach to family planning; messages that appeal to a woman actively planning a small family using modern contraception are unlikely to resonate with a woman who is wary of such methods. The behavioral drivers and sources of trusted information are different for different couples. As countries and partners continue to invest in family planning programs, they should consider using more targeted approaches so that they meet the assorted needs of these users. 

We anticipate that this research will help governments and partners to create more targeted, effective ways of encouraging and supporting family planning decisions in Madhya Pradesh and elsewhere.