Role of fear and misinformation about contraceptives in unmet need: Are we measuring it correctly? A case study in attitudes from Uttar Pradesh, India

BACKGROUND: The Demographic and Health Survey (DHS) has become the standard instrument to quantify unmet need for contraception. However, the usefulness of the DHS as a tool to identify reasons for unmet need remains questionable. In regions with high unmet need, such as Uttar Pradesh (21% among married women), it is imperative to be able to quantify and empirically analyze how attitudes about contraceptive methods (e.g. fear of side effects and misinformed health concerns) may become barriers to contraceptive adoption or reasons for method discontinuation. METHODS: Qualitative data from six focus group discussions and 48 in-depth interviews were analyzed for couples' experiences with contraception in two rural villages in Uttar Pradesh, between April-June 2008. In addition, quantitative data from India DHS 2005-6 was explored to identify contraceptive attitudes and empirical testing of qualitative results. RESULTS: Qualitative analysis revealed a high degree of negative attitudes about reversible contraceptive methods among users and non-users alike. These included beliefs that these methods were harmful to health; ineffective; cause weakness of the body; or cause permanent sterility. Quantitatively, data were very limited, and showed a discrepancy in results; health concerns and fear of side effects were indicated in only 17% of respondents with identified unmet need. CONCLUSIONS: Without attitudinal measures, the DHS is rendered insufficient to fully understand the reasons for unmet need, and limited data may be misleading. We are recommending an algorithm to improve the measurement of attitudes towards contraceptive methods to fill the gap in understanding the reasons for unmet need.