Gendered Dynamics of Contraceptive Decision-Making Among Currently Married Couples in Kerala, India: Insights From Qualitative Interviews

Introduction Contraceptive use among couples is skewed towards limiting methods, with male method use remaining very low. This reflects a complex interplay of gender power relations in contraceptive decision-making. This study explored the perspectives and experiences of currently married women and men regarding contraceptive decision-making in Kerala, and aimed to understand how gender operates within these processes. Methods Qualitative in-depth interviews were done among currently married men and women in the age group 18-35 years in the Thiruvananthapuram and Thrissur districts of Kerala. An in-depth interview guide was used to capture the data. Data were collected from 19 participants until data saturation was obtained in the local language (Malayalam). Thematic analysis was done to generate the major themes. Results Findings indicate that gender power relations, masculinity norms, family and community expectations, and communication gaps between partners play a significant role in contraceptive decision-making among couples in Kerala. Women, due to a lack of knowledge, fear initiating conversation on contraception, while men assume it need not be talked about, as it is given that women have to undergo sterilization once the family size is complete. This indicated the deep-rooted gender norms that drive contraceptive decision-making. Men also do not approve of undergoing male sterilization, as it is stigmatized and threatens the masculinity norms in the community. Conclusions The study highlights the need to move beyond the assumptions of autonomous choice and recognize contraceptive decision-making as a negotiated process that is embedded in social relationships. Programs on family planning should aim to adopt gender-transformative strategies that engage men in the process. In addition, the programs should also aim to develop interventions that help couples to have open and gender-sensitive communication to help them make informed choices.