Key Social Norms Take-aways This study highlights how entrenched social norms stigmatizing premarital sex in India shape healthcare providers’ attitudes and behaviors toward unmarried youth seeking contraceptive services. Providers often internalize and reinforce these norms, leading to restricted access to sexual and reproductive health (SRH) services for unmarried adolescents. Even when legally permissible, many providers hesitate or refuse to offer contraceptives due to fears of community backlash, concerns about their own reputations, and moral judgments. These findings underscore the need for provider training to confront internalized bias and create a supportive environment that respects the SRH rights of all youth, regardless of marital status.
Objectives The study aimed to explore the beliefs, preferences, and attitudes of family planning service providers in public health facilities in India regarding the provision of contraceptive services to unmarried youth.
Methods A qualitative study was conducted from October 2017 to September 2018 in four districts of Bihar and Uttar Pradesh. Researchers conducted in-depth interviews with 60 family planning service providers, including Accredited Social Health Activists (ASHAs), nurses, and family planning counsellors. Data were analyzed using grounded theory to identify emerging themes related to providers’ willingness to offer contraceptives to unmarried youth and the reasons behind their choices.
Results Providers were categorized into three groups: supportive, hesitant, and non-supportive. While 32 providers expressed a willingness to offer methods like condoms and emergency contraceptive pills, 10 were hesitant and 14 outright refused to provide services. Hesitant and non-supportive providers often cited social norms condemning premarital sex, fear of damaging their reputation, potential community backlash, or concern about contraceptive side effects. Some providers believed it was illegal to give contraceptives to unmarried youth. Others demonstrated gender bias by offering condoms only to boys, based on misconceptions or incomplete training. Supportive providers acknowledged the rising prevalence of premarital sex and emphasized the importance of SRH information to prevent unintended pregnancies and unsafe abortions.
Conclusions Despite legal permissions and growing need, many Indian healthcare providers limit contraceptive access for unmarried youth due to deeply held social norms. Addressing these provider biases is critical for ensuring youth-friendly, non-judgmental SRH services. Expanding adolescent-focused training and counseling services—such as the Adolescent Reproductive and Sexual Health (ARSH) program—and incorporating behavior change strategies like those from the Beyond Bias Project may reduce moral conflict and improve access for unmarried youth.