Peer-reviewed article
"An obedient wife never says "no" to her virtual god." High fertility conceptions and barriers to contraceptive use among mothers of Southern Pakistan: a qualitative study.
Ahmed F, Malik NI, Bashir S, Noureen N, Ullah S et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This qualitative study examined why mothers in rural Southern Pakistan have high fertility rates and avoid contraception. Researchers interviewed 20 mothers and 15 healthcare providers to understand their beliefs and practices. The study identified five major barriers: cultural traditions, economic difficulties, gender-related restrictions, religious beliefs, and medical concerns. Early marriage of girls, lack of women's decision-making power, and preference for male children all contribute to high fertility and low contraceptive use.
Key points
- Five major barriers to contraceptive use identified: cultural, economic, gender-related, religious, and medical complications
- Early marriage of girls is a cultural practice preventing birth spacing
- Women cannot make reproductive decisions without permission from male family members (husbands and in-laws)
- Religious beliefs frame contraception and birth control as sinful and against faith
- Mothers prefer male children and wish to continue bearing children until sons are born
Limitations
This qualitative study with 20 mothers and 15 healthcare providers from one region cannot be generalized across all of Pakistan or measure the prevalence of these barriers. The study does not quantify how many mothers hold each belief or compare outcomes between those who use contraception and those who do not.
Abstract
Issue Biomedical approaches want to change locals' behaviors without understanding the sociocultural rationales and contextualizing the cultural and structural backdrop of women's agency. Objectives This study explored the perceptions and practices of rural mothers about fertility and reproductive health and further examine the lack of preference for contraception and birth spacing in Southern Pakistan. Methodology Using purposive sampling we recruited 15 healthcare providers and 20 mothers from Southern Punjab. Key informants and in-depth interviews were used for data collection. We extracted themes and sub themes to analyse qualitative data. Findings Five major themes identified preventing birth spacing and contraceptive use: (1) cultural barriers (2) economic difficulties and demographic factors; (3) gender-related hurdles; (4) spiritual and religious obstacles, and (5) medico-ethical complications. Nearly, ten sub-themes contributing to these major themes were: custom of girls' early marriages, in-laws' permission for contraception, women's concern for medical complications and preference for safer methods, misuse of contraceptive methods by the medical community, mothers' perception of contraception as sinful act and controlling birth is against faith, economic and rural-ethnic factors for high fertility, masculine disapproval of condom use, and wishing to give birth to male children. Suggestions We advocate for understanding the sociocultural explanations for low contraceptive use and urge practice of more natural methods of birth spacing over commercial solutions. The study suggests socio-economic development of less developed communities and empowerment of poor, illiterate, and rural women along with behavior change communication strategies.