Client Perspectives on Barriers and Facilitators to Avail Family Planning Services During the COVID-19 Pandemic in Maharashtra, India: A Qualitative Study

This study is a part of a mixed-method study conducted in the Thane district of Maharashtra, which has experienced a high number of COVID-19 cases and fatalities. The study presents qualitative data obtained from 39 in-depth interviews (IDIs) and 27 focus group discussions (FGDs) with male and female participants who have and have not availed FP services during the pandemic. The interviews were conducted in Marathi and were translated and coded by skilled researchers. The analysis was conducted using a thematic content analysis approach. This study found that couples switched to short-term/less effective spacing methods, such as condoms and pills, as the family planning services were disrupted during the initial stage of the pandemic. These products were acquired from private pharmacies or with support from Accredited Social Health Activists (ASHAs). However, clients faced community-level barriers related to transportation, movement restrictions, community-level risk perceptions, and the perceived significance of FP services due to the pandemic and at individual level, delayed getting pregnant due to fear of COVID-19 and its long-term impact on the newborn. Meanwhile, the suspension of sterilisation services, conversion of health facilities for COVID-19 treatment, healthcare personnel shortages, fear of infection and mandatory facility testing were the key health system barriers hindering access to FP services. Clients often met their contraceptive needs by adopting alternative spacing methods or abstaining from sexual activity. They advocated for strategies such as door-to-door distribution of FP products, installing condom vending machines and ensuring ample stock for future pandemics. Furthermore, male clients emphasised the necessity for male FP counsellors and providers to alleviate discomfort in discussing FP with female ASHA workers.