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Understanding quality of contraceptive services from women’s perspectives in Gujarat, India: a focus group study
  1. Kelsey Holt1,
  2. Bella Vasant Uttekar2,
  3. Reiley Reed1,3,
  4. Madeline Adams4,
  5. Lakhwani Kanchan2,
  6. Ana Langer4,
  7. Sandhya Barge2
  1. 1Department of Family & Community Medicine, University of California, San Francisco, California, USA
  2. 2Centre for Operations Research and Training, Vadodara, Gujarat, India
  3. 3School of Social Welfare, University of California, Berkeley, California, USA
  4. 4Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
  1. Correspondence to Dr Kelsey Holt; kelsey.holt{at}


Objectives Understanding quality of contraceptive care from clients’ perspectives is critical to ensuring acceptable and non-harmful services, yet little qualitative research has been dedicated to this topic. India’s history of using incentives to promote contraceptive use, combined with reports of unsafe conditions in sterilisation camps, make a focus on quality important. The study objective was to understand women’s experiences with and preferences for contraceptive counselling and care in the public sector in India.

Design Qualitative study using eight focus group discussions (FGDs). FGDs were thematically analysed using a framework approach.

Setting Rural and urban areas in one district in Gujarat.

Participants 31 sterilisation and 42 reversible contraceptive users who were married and represented different backgrounds. Inclusion criteria were: (1) female, (2) at least 18 years and (3) receipt of contraception services in the last 6 months from public health services.

Results Providers motivate married women to use contraception and guide women to specific methods based on how many children they have. Participants found this common practice acceptable. Participants also discussed the lack of counselling about reversible and permanent options and expressed a need for more information on side effects of reversible methods. There were mixed opinions about whether compensation received for accepting long-term methods affects contraceptive decision making. While many women were satisfied with their experiences, we identified minor themes related to provider coercion towards provider-controlled methods and disrespectful and abusive treatment during sterilisation care, both of which require concerted efforts to address systemic factors enabling such experiences.

Conclusions Findings illuminate opportunities for quality improvement as we identified several gaps between how women experience contraceptive care and their preferences, and with ideals of quality and rights frameworks. Findings informed adaptation of the Quality of Contraceptive Counselling Scale for India, and have implications for centring quality and rights in global efforts.

  • reproductive medicine
  • quality in health care
  • qualitative research

Data availability statement

The data that support the findings of this study are available from the corresponding author on reasonable request.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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Data availability statement

The data that support the findings of this study are available from the corresponding author on reasonable request.

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  • Contributors KH and AL conceived of the study; BVU, SB, KL and KH designed study instruments; BVU, SB and KL conducted data collection; KH, MA, RR, SB, BVU and KL conducted the analysis; KH and RR drafted the manuscript; AL, SB, BVU, KL and MA provided substantive feedback on the manuscript.

  • Funding This work was supported by the David and Lucile Packard Foundation (Grant number 2016-64353).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.