Barriers and incentives in the uptake of family planning services: Evidence from the Universal Access to Quality Contraception Project

Population Services International (PSI) set out to demonstrate the engagement of the private sector in increasing access to modern contraceptives through innovative financing strategies, with a focus on marginalised populations, by implementing the SARAL or Universal Access to Quality Contraception (UAQ) project in the city of Agra, Uttar Pradesh. The objective of the UAQ program was to provide a full basket of choices of family planning methods to newly-married women, incentivising them to delay pregnancy for a specified period. A cross-sectional baseline survey was conducted in Agra during the month of June 2022, covering 1240 currently married women. Using baseline survey data, this paper examined the determinants of women's preference for an additional child, and whether supply-side family planning interventions alone are sufficient to drive adoption of family planning methods. Regression analysis was done to find the determinants of wanting more children and the determinants of the willingness to join the program. The results show that the two most significant variables in determining a womans preference for another child are the total number of children she already has, and not having any male children resulting in a strong son preference. The most significant variable in determining a womans preference for enrolling herself in the SARAL program is whether she has faced financial constraints in accessing family planning methods, with other determinants being inconvenience of using contraceptive methods, exposure to the governments outreach about family planning, and preference for a male child. The findings indicate that womens preferences for an additional child are mostly based on their own desires, and are generally determined by the number and gender of their existing children. However, when it comes to the use of family planning methods, the husbands views are a critical factor in making family planning decisions - this would imply that family planning programs need to reach out not just to women, but to their husbands as well. Raising awareness of, and increasing exposure to family planning services is much needed, and programs should incorporate a strong Information, Education and Communication (IEC) component.