Provider imposed restrictions to clients' access to family planning in urban Uttar Pradesh, India: a mixed methods study

BMC Health Serv Res. 2013 Dec 23:13:532. doi: 10.1186/1472-6963-13-532.


Background: Medical barriers refer to unnecessary policies or procedures imposed by health care providers that are not necessarily medically advised; these restrictions impede clients' access to family planning (FP). This mixed methods study investigates provider imposed barriers to provision of FP using recent quantitative and qualitative data from urban Uttar Pradesh, India.

Methods: Baseline quantitative data were collected in six cities in Uttar Pradesh, India from service delivery points (SDP), using facility audits, exit interviews, and provider surveys; for this study, the focus is on the provider surveys. More than 250 providers were surveyed in each city. Providers were asked about the FP methods they provide, and if they restrict clients' access to each method based on age, parity, partner consent, or marital status. For the qualitative research, we conducted one-on-one interviews with 21 service providers in four of the six cities in Uttar Pradesh. Each interview lasted approximately 45 minutes.

Results: The quantitative findings show that providers restrict clients' access to spacing and long-acting and permanent methods of FP based on age, parity, partner consent and marital status. Qualitative findings reinforce that providers, at times, make judgments about their clients' education, FP needs and ability to understand FP options thereby imposing unnecessary barriers to FP methods.

Conclusions: Provider restrictions on FP methods are common in these urban Uttar Pradesh sites. This means that women who are young, unmarried, have few or no children, do not have the support of their partner, or are less educated may not be able to access or use FP or their preferred method. These findings highlight the need for in-service training for staff, with a focus on reviewing current guidelines and eligibility criteria for provision of methods.

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Family Planning Services / supply & distribution*
  • Female
  • Focus Groups
  • Health Personnel / statistics & numerical data
  • Health Services Accessibility* / organization & administration
  • Health Services Accessibility* / statistics & numerical data
  • Humans
  • India
  • Interviews as Topic
  • Male
  • Marital Status
  • Middle Aged
  • Parity
  • Practice Guidelines as Topic
  • Qualitative Research
  • Urban Health Services / statistics & numerical data
  • Young Adult