Voices unveiled: a mixed-methods exploration of family planning education, access, and Sociocultural determinants for enhancing contraceptive decision-making in western Gujarat, India.

Abstract

Background: Contraceptive use plays a crucial role in achieving desired fertility levels and improving maternal and child health outcomes. This study aimed to estimate the prevalence and determinants of contraceptive use among married women in Western Gujarat, India, using a mixed methods approach.

Methods: A community-based mixed-method study was conducted. A multistage stratified cluster sampling technique was used to recruit 840 married women aged 18-49 years for the quantitative component. Bivariate and multivariate logistic regression analyses were performed to identify factors associated with contraceptive use. Additionally, 20 in-depth interviews and 4 focus group discussions were conducted to explore qualitative aspects of contraceptive use, using a purposive sampling technique.

Results: The contraceptive prevalence rate was 60.4%, with 46.7% using modern methods and 13.7% using traditional methods. Multivariate analysis revealed that higher education levels of women (graduation: aOR = 4.1, 95% CI: 1.4-12.0) and their husbands (graduation: aOR = 2.6, 95% CI: 1.0-6.9), women's employment status (not working: aOR = 0.6, 95% CI: 0.3-1.0), having 1-2 children (aOR = 3.6, 95% CI: 2.2-6.0), and joint decision-making was positively associated with contraceptive use. Age above 40 years (aOR = 0.2, 95% CI: 0.1-0.7) and contraceptive decisions made by other family members (aOR = 0.3, 95% CI: 0.1-0.8) were negatively associated with contraceptive use. Qualitative findings highlighted sociocultural barriers, such as community norms, religious beliefs, and gender power dynamics, as significant influences on contraceptive use.

Conclusions: This study provides a comprehensive understanding of the factors influencing contraceptive use in Western Gujarat. The findings underscore the need for multifaceted interventions that address individual, interpersonal, and sociocultural factors to improve contraceptive uptake and reproductive health outcomes. Interventions should focus on enhancing family planning education, improving access to services, promoting women's empowerment, and addressing sociocultural barriers.