Why sterilized so young? A mixed methods analysis of contraceptive options and family planning experiences in Uttar Pradesh

BACKGROUND: With a skewed contraceptive method mix, 37.3% of currently married women in India are sterilized, at a median age of 25.5. To improve contraceptive quality of care, it is important to understand this trend to reverse it in favor of a more balanced method mix including temporary methods. METHODS: Qualitative data from six focus group discussions and 48 in-depth interviews with couples were analyzed for family planning experiences in two rural villages in Uttar Pradesh, India between April-June 2008. Additionally, National Family Health Survey 2005-6 data was analyzed to identify the predictors of early sterilization (<25yrs) among 939 women in rural Uttar Pradesh RESULTS: Qualitative analysis revealed that many couples viewed female sterilization as the main and ultimate method of contraception; with scattered and arbitrary patterns of use for temporary methods. For 82% of women, sterilization was their first modern contraceptive method. Women were found more likely to have had a sterilization by age 25 if they did not use modern contraception before sterilization (OR=1.7,95%CI=1.1-2.7); were literate (OR=1.7,95%CI=1.2-2.6); from a scheduled caste (OR=1.1,95%CI=1.3-3.9) or backward caste (OR=2.3, 95%CI=1.5-3.6); were allowed to go to a health facility only when accompanied (OR=1.5,95%CI=1.1-2.1) or not at all (OR=2.8,95%CI=1.1-7.5),. CONCLUSIONS: Couples had their mind set disproportionately on sterilization and did not perceive use of temporary methods as a viable option in planning their families. Policies and programs to make reversible contraceptive methods more available, accessible and acceptable will improve the quality of care and generate a more balanced and informed contraceptive use environment.