{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T03:26:18Z","timestamp":1791170778233,"version":"4.1.0"},"reference-count":25,"publisher":"BMJ","issue":"10","license":[{"start":{"date-parts":[[2021,10,4]],"date-time":"2021-10-04T00:00:00Z","timestamp":1633305600000},"content-version":"unspecified","delay-in-days":3,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000008","name":"David and Lucile Packard Foundation","doi-asserted-by":"publisher","award":["2016-64353"],"award-info":[{"award-number":["2016-64353"]}],"id":[{"id":"10.13039\/100000008","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,9,21]]},"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Understanding quality of contraceptive care from clients\u2019 perspectives is critical to ensuring acceptable and non-harmful services, yet little qualitative research has been dedicated to this topic. India\u2019s history of using incentives to promote contraceptive use, combined with reports of unsafe conditions in sterilisation camps, make a focus on quality important. The study objective was to understand women\u2019s experiences with and preferences for contraceptive counselling and care in the public sector in India.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Qualitative study using eight focus group discussions (FGDs). FGDs were thematically analysed using a framework approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Rural and urban areas in one district in Gujarat.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>31 sterilisation and 42 reversible contraceptive users who were married and represented different backgrounds. Inclusion criteria were: (1) female, (2) at least 18 years and (3) receipt of contraception services in the last 6\u2009months from public health services.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Providers motivate married women to use contraception and guide women to specific methods based on how many children they have. Participants found this common practice acceptable. Participants also discussed the lack of counselling about reversible and permanent options and expressed a need for more information on side effects of reversible methods. There were mixed opinions about whether compensation received for accepting long-term methods affects contraceptive decision making. While many women were satisfied with their experiences, we identified minor themes related to provider coercion towards provider-controlled methods and disrespectful and abusive treatment during sterilisation care, both of which require concerted efforts to address systemic factors enabling such experiences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Findings illuminate opportunities for quality improvement as we identified several gaps between how women experience contraceptive care and their preferences, and with ideals of quality and rights frameworks. Findings informed adaptation of the Quality of Contraceptive Counselling Scale for India, and have implications for centring quality and rights in global efforts.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-049260","type":"journal-article","created":{"date-parts":[[2021,10,4]],"date-time":"2021-10-04T17:40:06Z","timestamp":1633369206000},"page":"e049260","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Understanding quality of contraceptive services from women\u2019s perspectives in Gujarat, India: a focus group study"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9093-4322","authenticated-orcid":false,"given":"Kelsey","family":"Holt","sequence":"first","affiliation":[{"name":"Department of Family & Community Medicine, University of California, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bella Vasant","family":"Uttekar","sequence":"additional","affiliation":[{"name":"Centre for Operations Research and Training, Vadodara, Gujarat, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reiley","family":"Reed","sequence":"additional","affiliation":[{"name":"Department of Family & Community Medicine, University of California, San Francisco, California, USA"},{"name":"School of Social Welfare, University of California, Berkeley, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madeline","family":"Adams","sequence":"additional","affiliation":[{"name":"Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lakhwani","family":"Kanchan","sequence":"additional","affiliation":[{"name":"Centre for Operations Research and Training, Vadodara, Gujarat, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Langer","sequence":"additional","affiliation":[{"name":"Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandhya","family":"Barge","sequence":"additional","affiliation":[{"name":"Centre for Operations Research and Training, Vadodara, Gujarat, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,10,4]]},"reference":[{"key":"2025121409584925000_11.10.e049260.1","unstructured":"WHO . Ensuring Human Rights in the Provision of Contraceptive Information and Services: Guidance and Recommendations. Geneva: : World Health Organization, 2014. Available: http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK195054\/ [Accessed 30 Sep 2020]."},{"key":"2025121409584925000_11.10.e049260.2","doi-asserted-by":"crossref","unstructured":"Visaria L , Ved RR . India\u2019s Family Planning Programme: Policies, practices and challenges. Routledge, 2016.","DOI":"10.4324\/9781315652498"},{"key":"2025121409584925000_11.10.e049260.3","unstructured":"HRW India - Human Rights Watch . India: target-driven sterilization harming women. hum. rights watch, 2012. Available: https:\/\/www.hrw.org\/news\/2012\/07\/12\/india-target-driven-sterilization-harming-women [Accessed 30 Sep 2020]."},{"key":"2025121409584925000_11.10.e049260.4","unstructured":"Mohanty S , Bhalla N . Indian activists welcome top court ban on \u2018sterilization camps\u2019 after women\u2019s deaths | Reuters. Thomson Reuters Found, 2016. 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Trends in contraceptive use worldwide. 2015, 2015."},{"key":"2025121409584925000_11.10.e049260.7","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.4103\/ijmr.IJMR_2067_17","article-title":"Family planning in India: the way forward","volume":"148","author":"Muttreja","year":"2018","journal-title":"Indian J Med Res"},{"key":"2025121409584925000_11.10.e049260.8","doi-asserted-by":"publisher","DOI":"10.2307\/1966669"},{"key":"2025121409584925000_11.10.e049260.9","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.contraception.2017.06.005","article-title":"Defining quality in contraceptive counseling to improve measurement of individuals' experiences and enable service delivery improvement","volume":"96","author":"Holt","year":"2017","journal-title":"Contraception"},{"key":"2025121409584925000_11.10.e049260.10","doi-asserted-by":"publisher","DOI":"10.1111\/sifp.12052"},{"key":"2025121409584925000_11.10.e049260.11","doi-asserted-by":"crossref","unstructured":"Tumlinson K . 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