Preventing high-risk pregnancies: a qualitative analysis of contraceptive needs in women with cardiac disease in a tertiary care center in Sri Lanka

Cardiovascular disease complicates pregnancy and is a leading cause of indirect maternal mortality in low- and middle-income countries (LMICs). Despite Sri Lanka’s advanced maternal healthcare infrastructure, systemic and sociocultural barriers perpetuate unmet contraceptive needs among women with cardiac disease, contributing to preventable maternal morbidity in Sri Lanka. Existing guidelines from high-income countries inadequately address LMIC-specific challenges, necessitating contextually relevant, patient-centered solutions. To qualitatively analyze the contraceptive needs, barriers, and decision-making experiences of women with cardiac disease in Sri Lanka. A qualitative case study grounded in an interpretivist paradigm using purposive sampling of 12 women aged 25–45 years with cardiac disease admitted for pregnancy termination at a tertiary care center was conducted. Semi-structured interviews, analyzed using Braun and Clarke’s thematic framework, explored awareness of contraceptives, healthcare interactions, and sociocultural influences. We constructed the following themes through analysis: (1) limited awareness of contraceptive options, with misconceptions about the safety and efficacy of long-acting reversible contraceptives; (2) inconsistent counseling practices, where pregnancy risks were emphasized but contraceptive guidance was fragmented; (3) systemic barriers, including siloed cardiac and reproductive care, COVID-19 disruptions, and urban-rural disparities; (4) strong willingness to adopt effective contraception if supported by patient-centered counseling and reliable access; (5) coerced reproductive decision-making with sociocultural pressures, particularly patriarchal norms, compelled women to prioritize familial expectations over medical advice; and (6) intentional nondisclosure of health risks due to fear of stigma or marital conflict led women to withhold cardiac disease severity from families. Participants highlighted gaps in provider knowledge, gendered decision-making norms, and inadequate follow-up mechanisms. This study emphasizes the imperative need to integrate reproductive health into cardiac care protocols in LMICs. Policy priorities include multidisciplinary care models, exploring provider perspectives and provider training on patient-centered contraceptive counseling, and community engagement to address sociocultural barriers.