Informed Consent and Family Planning Services in India: Who is Informed, and Whose Choice Is It?

Background: It has been shown that in many international settings, women have little opportunity to be informed about, or voluntarily choose, contraception, calling into question the relevance of Western bioethics emphasis on the practice of “informed consent”.  The ideal of respecting women’s autonomy regarding their reproductive lives is, however, one that has been defended as an international goal and a human right.  Yet in Northern Indian, women’s autonomy is constrained by family members, healthcare personnel, and structural and gender inequalities.  These factors directly impact a woman’s ability to make or exercise autonomous and informed decisions related to her reproductive life. 

Study Purpose: This study explores how rural women living in Uttar Pradesh, India view their own decision-making power, and how they experience interactions and consent processes with healthcare providers when seeking contraceptive services.

Methods: In-depth interviews were conducted with currently married women aged 19-49 from June-August 2012 in the districts of Meerut and Bijnor in Uttar Pradesh, India.  A semi-structured interview guide was field-tested prior to recruitment of study participants.  Villages for the study were purposively selected based upon areas in which there is current demand for contraceptive services.  Interviews were conducted in Hindi and were digitally recorded.  Data analysis was based on constant comparison, rooted in grounded theory.

Results: A total of 48 women were interviewed, many of whom had to seek permission from their husbands to participate.  Women described controlling constraints exerted by husbands, mothers-in-law, and healthcare personnel, when wanting to stop or delay child bearing, or adopt contraceptive services.  Women reported pressure from families to continue bearing children until a son had been born, and that that they must seek permission from husbands and mothers-in-law to use contraception.  Several women reported that they were not counseled at all by a healthcare provider when they sought contraceptive services, and those counseled usually were informed of only one method.  However, women did report that healthcare providers discussed services with their husbands.

Discussion:  Public health professionals may be better positioned to promote women’s reproductive autonomy by designing programs that address the constraints on autonomy identified in this research.