A qualitative analysis of women’s reproductive agency and postpartum family planning in Maharashtra, India
Outcomes: Sexual and Reproductive Health
View SourceKey Social Norms Take-aways Social norms strongly constrain postpartum family planning (PPFP) through expectations around son preference, limited female autonomy, and the perception of contraception as a sensitive and stigmatized topic. Women’s reproductive agency is often mediated by husbands and in-laws, with covert contraceptive use emerging as a strategy to navigate restrictive norms. Norms around confidentiality, male approval, and limited open discussion of family planning significantly hinder access and informed choice.
Objectives To examine how women’s reproductive agency, social norms, and health system interactions influence access to and use of postpartum family planning in rural Maharashtra, India.
Methods The study used a qualitative design with 62 in-depth, semi-structured interviews conducted among postpartum women, husbands, mothers-in-law, frontline health workers, and community leaders. Data were analyzed inductively using thematic coding informed by Bronfenbrenner’s Ecological Systems Theory, with a focus on agency and multilevel social norms shaping PPFP behaviors.
Results Five key themes emerged. First, access to PPFP counseling and services was limited, especially for marginalized populations. Second, women had constrained reproductive agency, often requiring husband or family approval, with son preference shaping contraceptive decisions. Third, misinformation and myths about contraception—particularly regarding side effects—reduced informed choice. Fourth, social norms framed contraception as taboo, limiting open discussion and increasing the importance of confidentiality. Fifth, quality of care was poor, with prescriptive counseling, limited method choice, and inadequate information on side effects, leading to dissatisfaction and low uptake. Across themes, male partners and family members played decisive roles in shaping women’s access and decisions.
Conclusions Improving PPFP uptake requires addressing both structural and normative barriers. Programs should strengthen counseling quality, expand access, and promote informed choice while actively engaging men and families. Crucially, interventions must target restrictive gender norms and stigma surrounding contraception to enhance women’s reproductive agency and enable more equitable and informed decision-making.
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