Challenges in Modern Contraception Access among Married Bonda Women: Insights from a Qualitative Study on Family Planning Barriers and Healthcare Dynamics

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Sharma This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3940688/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Family planning practices play a crucial role in avoiding unintended pregnancies and the preventable mortality associated with childbirth that occurs either ‘too soon’ or ‘too frequently.’ These practices significantly influence the health outcomes of mothers, newborns, and children. Aim This research aims to conduct a qualitative investigation to gain a comprehensive understanding of the existing barriers related to modern family planning methods, along with contraceptive use, the management of unwanted pregnancies, and spacing between two children. Also, the study examines the influence of healthcare providers, mothers/mothers-in-law, and husbands on family planning practices within the Bonda tribe in the Malkangiri district of Odisha, India. Methods Utilizing a qualitative method, the investigation incorporated 8 Focus Group Discussions, 7 In-depth Interviews, and insights from 16 key informants. Results Thematic analysis was employed to reveal instances of unconsented contraceptive procedures, reproductive health complications, and challenges in contraception methods: unraveling societal dynamics and cultural barriers impacting family planning practices among Bonda women. Conclusions The study highlights the crucial need for enhanced maternity care and underscores the importance of culturally sensitive services. Furthermore, it promotes provider training to ensure satisfaction, equity, and professionalism in care childbirth for tribal women. The findings strongly indicate that addressing these issues can potentially enhance family planning outcomes among the Bonda tribe. Challenges Contraceptives Awareness Family Planning Copper-T Gender preference physical violence Barriers Bonda women Odisha Introduction Family planning (FP) plays a critical role in the progress of any nation through human development. FP refers to a way of living, thinking, and making responsible decisions voluntarily by individuals and couples, based on knowledge and attitudes (WHO, 2007 ). Along with contraceptive use, FP covers different means such as information, policies, attitudes, services, commodities, and practices, that help to generate the ability of couples, adolescents, and men/women to avoid unplanned conception as well as when and whether they schedule having progeny (Starbird et al., 2016 ). FP and contraceptive programmes help to control population growth and tend to positively affect different socioeconomic factors, such as enhancement of the opportunity for education, a decrease in poverty levels, and promotion of gender equality (Danton, 2014 ). Likewise, these practices offer the prospect of enhancing maternal and child health, through the avoidance of early and unwanted gestations, risky abortions, and the inhibition of different sexually transmitted diseases (STIs) (Hubacher et al., 2008 ). To achieve sustainable development goals (SDGs), the UN has prioritized the increase and utilization of FP and contraceptive use services in a sustainable way as one of its distinguished strategic investment emphasis agendas (Starbird et al., 2016 ). By 2030, individuals will achieve the target of collective access to sexual and reproductive health (SRH)-related services, together with FP, information, and education, through the use of different FP/contraceptive service-related programs at the community and national levels (Buse & Hawkes, 2015 ). Globally, different services/programmes related to FPs/contraceptives play key roles in promoting and increasing the frequency of contraceptive practices at the community level. Despite this, the acceptance of FP/contraceptive methods/services is still low in several worldwide pockets, including Asian and Latin American countries, and remains the least common statistic in sub-Saharan regions of the African continents (Moreland & Talbird, 2006 ). UN’s report on FP mentioned that globally as well as regionally, the share of women who adopted any contraceptive methods to avoid unintended pregnancy is comparatively maximum among women between the age group of 25 to 44 years, contrastingly reported lowermost among women of age group below the age 25(UNDESA, 2022 ). Worldwide, among the 1.9 billion (15–49 years) women, 966 million who use any contraception methods are categorized as 874 million who have adopted a modern method and 92 million who have adopted a traditional contraceptive method (UNDESA, 2022 ). The National Family Health Survey 5 (NFHS-5), which was conducted between 2019 and 2021, reported that 53% of tribal married women in India use any modern contraceptive practices (i.e., below the national average), where more than 80% of the users receive FP-related information from health workers as well as from public health facilities (Panda et al., 2023 ). On the one hand, the FP is often described as an issue related to women, but men influence family planning choices; on the other hand, in major cases, women and men both know about different commonly used family planning practices, but still, they do not understand them entirely (Dansereau et al., 2017 ). Different studies across the globe have highlighted the factors/barricades associated with the rate of acceptance and refusal of FPs and/or the use of contraception methods as their choices, viz. ethnicity, maternal education, age, individual perceptions, marriage, number of pregnancies, delivery location, household wealth, insurance status, receiving guidance/advice from a health care provider, unavailability of the ideal method/trained personnel for FP, the decision-making power of the female, fear of method’s side effects, myths/misconceptions, discouragement from intimate partner/closest friends, cultural opposition and religious perception(Dansereau et al., 2017 ),(Nazar-Beutelspacher et al., 1999 ), (Estrada et al., 2008 ), (Darney et al., 2016 ), (Rios-Zertuche et al., 2017 ), (Abdi et al., 2020 ), (Mushy et al., 2020 ) but not limited to these. Various similar studies have also been reported on the Indian subcontinent among different population groups, including tribal populations (Panda et al., 2023 ), (Hall et al., 2008 ), (Ghule et al., 2018 ), (Palo et al., 2020 ), (Sowmya et al., 2020), (Shewale & Sahay, 2022 ). A review of the literature reveals that barriers to the acceptance and use of modern FP methods and contraceptive use are still found at low utilization levels and are very unsatisfying among tribal populations; moreover, even a number of microlevel community-based studies have not been performed in diverse socioenvironmental settings. To fill this gap, the present study involved a qualitative investigation to obtain an in-depth understanding of the existing barriers to modern FP, contraceptive use, the management of unwanted pregnancies, and the spacing between two children among the Bonda, a particular vulnerable tribe group (PVTG), which is confined to the restricted hill pockets of the Eastern Ghats Mountain Range located in the Malkangiri district of Odisha, India. Simultaneously, how health care providers, specifically mothers/mothers-in-law and husbands within the family, influence Bonda women's FP practices was explored. Materials and methods Study setting, study subjects, and sample size For this study, the Malkangiri district of Odisha was purposively selected. Malkangiri is situated in the southern part of the state of Odisha. The eastern portion of the Malkangiri district of Odisha state is sparsely inhabited by different primitive tribes, distinguished by 02 particular vulnerable tribal groups (PVTGs), viz. Bondas and Didayis, along with Koyas and Porajas (About District Malkangiri, Government of Odisha, 2023). The present qualitative explorative study was conducted among the eligible married couples of Bonda PVTGs as well as health workers and other government officials in the region of interest between December 2021 and July 2022 in the Khairput block of the Malkangiri district, Odisha, located in the lining of the Kondakamberu Range of Eastern Ghats (AB Ota, 2007 ). In the emic nomenclature, they knew themselves as ‘ Remo ’, or ‘ People ’ (Verrier Elwin, 1950 ), where two social divisions exist—‘Gor Remo ’ and ‘ Janga Remo’ (the mother tongue of Bonda ) ‘Talar Bonda’ and ‘Upar Bonda’ (a widely speaking native language) ‘ lower’ and ‘ upper’ Bonda (English) among them and their livelihood moves around subsistence type extensive step cultivation, forest collection, and minor hunting. This study aimed to investigate the reproductive health of women from both the lower and upper Bonda tribes. The research utilized a stratified random sampling approach to select participants from villages, with a focus on areas with established CHCs/PHCs/SHCs as centers. Five specific Gram Panchayats (GPs), Kadamguda, Rasbeda, Khairput, Mudulipada, and Andrahal, were chosen due to their significant Bonda population. Participants were selected through a purposive sampling approach, where villages were chosen randomly. The study targeted married Bonda women aged 15–49 years from both the lower and upper Bonda. A total of 69 participants (26 from Lower Bonda and 43 from Upper Bonda) participated in the study, with 8–9 partakers in each FGD group. Likewise, 07 in-depth interviews (IDIs) (04 among Lower Bonda and 03 among Upper Bonda) were conducted among Bonda married female participants (15–49 years), and 16 IDIs were conducted with local health care providers, teachers, postmasters, and businessmen at the locality. The first FGDs and IDIs included participants from both younger and older age groups (15–49 years) to ensure diverse perspectives. This approach aimed to provide all participants with the opportunity to share their opinions without feeling any pressure. Second, IDIs were conducted with medical staff, including Doctor, Pharmacist, ANMs, and Asha/Anganwadi (AW) workers working in the study area. Third, female postmasters, female teachers, and local businessmen/women were asked about the IDIs. Inclusion criteria and selection of study participants In this study, the participants involved were married women belonging to the Bonda PVTG group aged between 15 and 49 years who had given birth to one or more children. The participants were selected based on their age and history of contraceptive use. Likewise, the local health care providers, appointed by the government and nongovernment, viz. ASHA, Anganwadi Workers (AW), Female Attendants of the Health and Wellness Centre, Auxiliary Nurse Midwives (ANM), Pharmacists, and Doctors were interviewed. Other key informants, such as female postmasters, female teachers, and local businessmen/women, were also asked. Method of data collection As in the tribal context, the FP is a very sensitive issue; during the FGD, the study participants were grouped according to their education, profession, and age. Similarly, the married women were identified from the updated records kept by the AW and ASHA from different small villages and hamlets. The investigator conducted interactions with married women in either the Remo Sam dialect (the mother tongue of Bonda) or Desia (a widely speaking native language) in the Odia language with health workers and key informants. The data were collected via a qualitative approach (with FGD and IDI) through different pretested semi structured interview schedules. Here, the duration of IDI was approximately 20–45 min, whereas the duration of FGD was 60–90 minutes. Ethical consideration Ethical approval for the study was obtained from the Institutional Ethics Committee at Dr. Harisingh Gour Vishwavidyalaya, Sagar-470003, M.P., India; the letter number is DHSGV/IEC/2022/05. Before their involvement in the study, all the volunteer participants were informed about the study purpose, privacy, advantages, and risks involved in the research, and written informed consent was obtained from all participants through signatures or thumb impressions where they were illiterate. Informed consent was obtained from the female volunteer participants younger than 18 years after receiving consent from their spouse. Data Analyses Braun and Clark’s thematic content analysis techniques were applied. All the FGDs and IDIs were either audio recorded or noted in the field diary of the researcher, and the data collected from the FGDs, IDIs, and key informants were transcribed verbatim and translated into Odia to English. The English-translated stories were then typed into a word processor for data analysis so that the data could be easily analyzed. First and foremost, the researcher became acquainted with the data by reading and rereading the narrative stories. After that, the studies were coded manually and in order. Afterwards, the studies were listed, sorted, excluded, combined, and subcategorized, and examined for associations between them and logical analysis. The topics were cross-checked for validity and accuracy before being reviewed. In the final step, the themes and subthemes were defined, and their names were written. The research questions and objectives of the study determined how subthemes and themes would be generated from the codes (Table no.3). Socio-demographic characteristics of key informants Table no.1 (n = 16) Asha/Anganwadi n = 07 ANM/Female attendant n = 03 Doctor/pharmacist n = 02 Administrators n = 04 Age in years < 30 1 0 1 1 30–39 5 3 0 1 40–49 1 0 0 2 ≥ 50 0 0 1 0 Marital Single 2 3 0 1 married 5 0 2 3 Widowed 0 0 0 0 Gender Female 7 3 0 3 Male 0 0 2 1 Participants Description Table no.2: Participants description (n = 69) Variables Frequency (N = 69) Percentage Age group 15–30 22 31.9 31–49 47 68.1 Education None 49 71.0 Primary 7 10.1 Middle 7 10.1 Secondary 3 4.3 Higher Secondary 3 4.3 Location of the study Lower Bonda 26 37.7 Upper Bonda 43 62.3 Occupation Home Maker 1 1.4 Forestry 41 59.4 Agriculture 21 30.4 Pvt. Job/Business 3 4.3 Peon 2 2.9 Teacher 1 1.4 No. of children 0–1 11 15.9 02–03 31 44.9 04–05 18 26.1 6+ 9 13 Name of the contraceptives used Pill 11 15.9 Copper-T 15 21.7 Condom 2 2.9 Female Sterilization 5 7.2 Not used anything 36 52.2 The study involved a total of 69 women from the Malkangiri district of Odisha. The participants came from lower socioeconomic backgrounds, indicating that they may have faced economic challenges or belonged to lower-income households. Most of the women in the study area worked in the fields of forestry and agriculture. The profile of the study group was predominantly composed of women aged 31 to 49 years. More than half of the women in the study had no formal education. Most of the women in the study had two or three children. All the Asha/Anganwadi individuals were female, all were from the Bonda tribe, the ANMs were in other groups, and most were younger than 35 years. The doctor and pharmacist were male and aged less than 50 years (Table no. 2). To identify the causes of misconceptions and barriers and design preventative measures, it is important to investigate the viewpoints of women and healthcare professionals regarding modern family planning methods during the period of reproduction. In a broader discussion of family planning obstacles, Bonda women voice strong objections to nonuse and prevent others from giving it a second thought. However, taking a deeper look at the acceptability of and obstacles to the use of contemporary contraceptives in specific circumstances reveals slight variations that are thoroughly examined in this paper. The study examines the accessibility for women and providers, the hurdles confronted by Bonda women, and the responses of participants who have experienced such challenges. Four main themes and nine subthemes were identified from the data, viz. 1) Awareness and practices of FP methods, 2) access barrier to reproductive health services, 3) cultural and societal expectations related to gender roles and family dynamics within the Bonda community, and 4) perceptions of healthcare providers. The findings are presented with quotes from the participants under each theme and subtheme (Table No. 3). Table no.3 Presents the major themes, sub-themes, and codes. Main Themes Sub themes Codes 1. Awareness and practices of FP methods (I) Disparities in Contraceptive Knowledge among Bonda women: a comparative analysis and Source of Information Female sterilization, copper-T, Pills, condoms, and Antara, Asha/Anganwadi/ANM, spouses, and friends (II) Traditional perception and cultural barriers Uncomfortable/shy learning, timing of meeting, ashamed to attend meeting, spoke nonsense 2. Access Barrier to Reproductive Health Services (I) Unconsented Contraceptive procedures and Reproductive Health Complications Health issues, Healthcare provider insert Copper-T without consent, Doctor were not available, left without proper stich (II) Side Effects and Refused to accept Side effect of Copper-T on health, never ask anyone to use it (III) Navigating Myths and Barriers: Bonda Women and Contraceptive Misconceptions Used copper-T Lead to cancer, will melt inside the Body, Unable heavy lifting, unable to climb mountains, long gap of have conceived, shortage of milk (IV) Factor influencing contraceptive decision. Husband/Mother-in-law, safety of child, physical violence 3. Cultural and Societal Expectations related to gender roles and family dynamics within the Bonda community (I) Gender preference, Economic Influences, and Future Support Concerns Girl child, Boy child, financial and old age support, Jalla (Bride price) (II) Challenges in Contraceptive Among Bonda Husbands: Unravelling Societal Dynamics Husband does not allow wives, husband opposes, sexual desire, fear of losing, Healthy and attractive, capture women, marry another woman 4. Perceptions of healthcare providers I) Resistance faced by the health workers while giving counseling/services Lack of awareness programs, mislead, partially giving information, neglect adequate rest, drinking alcohol Results The results presented below explain the experiences of married Bonda women during contraceptive access, highlighted the impact of personal and cultural factors on the use and discontinuation of contraceptive methods. Theme:1-Awareness and practice of family planning methods Subthemes: (I) Disparities in Contraceptive Knowledge among Bonda Women: a Comparative Analysis and Source of Information Participants in the study demonstrated varying levels of knowledge regarding contraceptive methods, with some possessing awareness of at least one method. In contrast, others remained uninformed and were not motivated to consider contraception in the future. The disparity in knowledge among Bonda women residing in upper and lower regions was remarkable. Lower Bonda women who resided on hill slopes and had more connections with mainstream society had a greater awareness of contraceptive methods. Patients in this group were more likely to use alternative contraceptive methods for female sterilization or copper-T as a means of birth control. The increased exposure to external influences contributed to a better understanding of the significance of contraceptives among these lower Bonda women. On the other hand, upper Bonda women, isolated in hilly regions with limited access to external groups and media, lacked sufficient knowledge about birth control methods. The geographical exclusion of this group caught up with their exposure to information regarding contraception options. Among the contraceptive methods known by both groups were female sterilization, copper-T, contraceptive pills, condoms, and Antara. These methods represent a shared baseline of knowledge, though with differences in prevalence and adoption option rates. Primary sources of information for women in both groups included Asha/Anganwadi/ANM, spouses, and peer groups. These media played a crucial role in spreading information about contraceptive methods and influencing women’s decisions regarding FP. Subtheme: (II) Traditional Perception and Cultural Barriers According to the Bonda women, the practice of having children annually is observed as indicative of a healthy mother contributing to a positive social identity and supporting the traditional role of motherhood. This perspective is rooted in the belief that each child is considered a divine gift to the family. The Bonda people express shyness during such discussions, reflecting their deep attachment to traditional cultural norms. The persistent prevalence of historical practices makes it challenging for them to willingly adopt modern contraceptive methods, leading to difficulties in education on family planning methods. Several barriers contribute to the hesitancy of Bonda women to adopt modern contraceptive methods. These include the cultural shyness surrounding discussions about contraceptives with spouses and healthcare staff, challenges related to the timing of meetings, and the constant observance of cultural norms and values. These factors collectively restrain the acceptance of contemporary FP practices within the Bonda community. The following quotes support these points. “Bonda women are unwilling to attend Anganwadi and VHND meetings because they are uncomfortable/shy learning about contraceptive methods and their uses. They think that if they go to attend meetings, then their work will stop; hence, half of them will not come to the meetings. In addition, yes, one good thing from the government happened: those who attend VHND meetings and antenatal care get nutritional food; due to this, some prefer to attend meetings, and some of them do not”. (Interview, Asha/Anganwadi) “When I go to call mothers to attend the VHND meeting, she told me I can’t come, I have work today, I have work to go here and there, and if I come to the meeting who will do our work? If you are giving something, then give it to my daughter or my neighbors. I will come and collect it in the evening”. (IDI, Asha/Anganwadi) “The Bonda women were opinionated; the healthcare provider spoke nonsense about contraceptives in the meetings, which we feel were ashamed to attend”. (IDI, Upper/Lower Bonda) “Since the Bondas lack knowledge and are thought to be quite stubborn, teaching them about family planning and spacing methods is very challenging ”. (Interview, Key informants) Theme: 2 Access Barriers to Reproductive Health Services Subtheme (I): Unconsented Contraceptive Procedures and Reproductive Health Complications: During the interview, the researcher noted that the participants were completely helpless in terms of their health. “ Didi, it has been five to six years, I am not feeling well, I have weakness and dizziness, white discharge and I am not able to eat properly and cannot do any household work. When I gave birth to my third child, this happened to me ……. ASHA and the health worker placed Copper-T on my vagina without consent. When I came to know that there was a lockdown, I could not remove it. Earlier, I used to go to Dishari (a traditional healer) regarding my health issue, but I could not overcome it. When the lockdown was opened, I went to CHC three to four times to get this copper-T removed, but always a new problem arose for me……. When I go to the hospital, the doctors were not available at the hospital”. (IDI, Upper Bonda, 38-year, User) The use of contraceptive methods has unintended consequences, including a reduction in household productivity and increased medical care costs for women. This not only makes the woman feel like a barrier to the household economy but also affects her physical well-being, reducing her engagement in various activities. Consequently, she struggles to fulfill her responsibilities toward her children and spouse, leading to a negative impact on her mental health. Additionally, limited housing options for healthcare professionals, such as doctors, pharmacists, and ANMs, create accessibility issues, causing inconveniences for patients seeking timely medical assistance. This presents ethical and legal issues because, in general speaking, medical procedures should be carried out only with the patient's informed consent. Furthermore, the study identified communication gaps between individuals and healthcare providers, occurrences of negligence or violent behavior by health workers, and a lack of spousal awareness as factors influencing reproductive behavior. Husbands who are not familiar with family planning may discourage their spouses from using these services, which is made worse by the reality that spouses are often unaware of family planning information because it is primarily shared with women by healthcare professionals. The following participant quotes highlight these challenges. “ Without my consent, Aasha/Health worker inserted a Copper-T and left without a proper stitch after 6 days of delivery. I show that the copper-T was removed automatically”. (FGD, Upper Bonda, 37-year-old user) “When I gave birth to a boy at CHC, the IUD (Cu-T) was inserted by the health worker, without informing me or my husband. After coming back home, when we get intimate with my husband, my husband noticed the thread was hanging outside the vagina. He asked me what this was and what I did, I told her I didn’t know anything about this. In addition, the next morning, immediately, he took me to the hospital. He pressurized the doctor to remove it”. (Interview, Upper Bonda, 32 years) The insertion of the IUD (Cu-T) without informing the woman or her husband raises concerns about the lack of proper informed consent. The health worker's failure to communicate the IUD (Cu-T) insertion to the couple led to confusion and concern when they found it during intimate moments. The fact that the husband detected the IUD (Cu-T) thread hanging outside the vagina during intimacy highlights the potential emotional and physical consequences of the lack of communication. The husband felt the need to pressure the doctor to remove the IUD (Cu-T), indicating a breakdown in trust and dissatisfaction with the medical procedure. The incident raises questions about faithfulness to patient rights, as every individual has the right to be informed and involved in decisions about their healthcare. This situation emphasizes the need for better patient education regarding contraceptive methods, their potential side effects, and the importance of clear communication between healthcare providers and patients. The incident may lead to quick analysis of healthcare practices to ensure that proper protocols for informed consent are followed to avoid such situations in the future. “When I delivered my baby in the CHC, the placenta was not delivered. Doctors and nurses entered my vagina area 4 to 5 times and failed to remove it. The CHC Doctor had referred me to the government hospital (Mathili Medical). The doctor successfully removed it by cutting off private parts. The nurse then left some areas without proper stitches, which caused severe bleeding, and the patients were repeatedly stitched. In addition, they used Copper-T on the vagina that was me and my husband without permission. After 3 days, I returned home and noticed that a thread was hanging in my private area. I pulled out the thread, and then the copper-T was removed. I was very afraid of seeing that. Again, I went for the second stitch to the CHC”. (IDI, Lower Bonda, 22years) This story sheds attention on the participants’ difficult pregnancy and delivery experiences as well as the medical issues she faced. The study also revealed the absence of appropriate treatment and consent in the healthcare system. Subtheme (II): Side effects and refusal to accept. The study's findings indicate that the main factor leading to the discontinuation of contraceptives, despite a desire to avoid pregnancy, is the occurrence of side effects. Respondents uniformly held the perception that the use of contraceptives could lead to adverse effects such as weakness, dizziness, pelvic pain, and irregular menstruation, indicating a significant concern for their physical health. The prevalent opinion among women is a consistent decision to never repeat contraceptive usage and a strong preference to oppose others from using them, emphasizing a prevalent lack of knowledge about contraceptives. The quotes below provide insights and support these key findings: “Didi, Asha, and the health worker inserted a Copper-T into my vagina. Since that, I have suffered from pelvic pain, dizziness, and a sore smell; often, I get senseless doing some work. In addition, facing irregular menstruation”. (FGD, Upper Bonda, Lower Bonda) “ I Got married by elopement in the year 17. At 18 years old, I got pregnant and delivered a baby girl. Asha workers and health workers used copper-T without informing me. I got to know about copper-T after 3 years of delivery. During this period, I was continuously having irregular menstrual bleeding for a long time. I went to the medicine shop and bought some medicine to not bleed. I used medicine for 3 months, and I went for a local medicine man for local medicine. The man gave me Deshi medicine (traditional medicines) after 3 days of eating, at which point the bleeding stopped. However, after that somehow, I knew Copper-T was there, I went to the CHC, and Asked the doctor to remove it”. (IDI, Lower Bonda, 24 years) “After my first childbirth, I used copper T, and it felt health problems such as back pain, badly smelling discharge, fear of side effects, and fear of future fertility. I removed it after 6 months of use. Not recommended for future use to anyone”. (IDI, Lower Bonda, 24 years) “I never used it because I feared hearing about the side effects, and I will never use it in my life and will never ask anyone to use it”. (FGD, Lower Bonda) Subtheme (III): Navigating Myths and Barriers: Bonda Women and Contraceptive Misconceptions The Bonda women’s views on a prevalent myth that accepting family planning methods would reduce women incapable of performing strenuous work. Residing at a hill station, the Bonda engaged in demanding responsibilities such as labor, slash cultivation, and crop harvesting to secure food for the following day, they did not waste a single day for rest. The lack of prior information and consent for copper-T application results in mistrust and contributes to contraception discontinuation. Myths surrounding Copper-T, such as its displacement into the abdomen causing cancer, concern about fertility, milk shortage, irregular menstruation, and diminished earning capacity, stemmed from misinformation spread by friends, relatives, and husbands. These misconceptions form significant barriers to the adoption of this contraceptive method. “ After using copper T, it will lead to cancer, it will go inside the chest and melt”. (FGDs, Lower Bonda) “ Didi, if we used it, we would not be able to do the heavy lifting, climb mountains, or lugbur lug (slash cultivation) because it will affect our health in terms of weakness, dizziness, backache, and heavy menstrual bleeding”. (IDI, Upper Bonda) “Didi, when I consumed the Mall-D (Pill) tablet after one childbirth. After a long gap, I have conceived”. (FGDs, Lower Bonda) “Didi, when I used copper T, my health issues arose like, after delivery, there was a shortage of milk”. (FGDs, Lower Bonda) Subtheme (IV): Factors influencing contraceptive decisions. As a whole, the story emphasizes the difficulties and complexities associated with family planning decisions, such as the influence of cultural expectations on reproductive decisions among the Bonda people. There are communication gaps in married relationships, and in the role played by mothers-in-law in influencing daughters-in-law's decision to use contraception. The situations discussed above highlight the need for spouses to communicate better and understand the importance of women's reproductive health. The study places a strong emphasis on physical violence against women and the safety of the child first. The study also highlights that the husband is drunk and harassing the woman mentally. These elements were found to be significant barriers preventing the use of contraceptive methods. “When my husband came to know about copper T, that I was using without his consent. He used to come home getting drunk and beat me”. “My mother-in-law also scolded me every day-night after drinking alcohol…because my mother-in-law was afraid, I would not be able to give birth child in the future”. (FGDs, Upper Bonda 33 years) “After giving birth to my second child, I had to take copper T, I took copper T on my own choice, and my spouse did not know about it. He always used to come at night after drinking, and due to this, I never discussed it with him. After 25 days of delivery, he was trying to get physical with me. When I refused to intimate him and tried to tell him, he got angry. He scolds me harshly pick up my 25-day child and threw him outside the home. The child’s leg broke, and he scolded me and warned me if you do not support me, I would marry another girl. The researcher asked her if she removed Cooper-T after the fight, and she said no I did not remove it I used it for two years. I told the doctor that again (Sir) I have been using Copper-T for 2 years, so now I want to remove it, they removed it, and now I want a girl child: then, I will go for female sterilization”. (IDI, Lower Bonda, 28 years) Theme 3- Cultural and Societal Expectations related to gender roles and family dynamics within the Bonda community. Subtheme (I): Gender preference, Economic Influence, and Future Support Concerns The following statements reflect sociocultural perspectives and concerns regarding gender roles, family dynamics, and expectations in the context of the Bonda community. In the Bonda community, the birth of girls is associated with increased bride prices. The cultural concept of ' Jalla ,' or the bride price is viewed as a source of income when a daughter marries and enhances household capabilities. This is in contrast with the idea that boys may leave their parents after marrying. Gender-based roles and responsibilities are distinctly defined, with the expectation that daughters will provide multifaceted support, economic support, and caregiving, while sons are proposed as potential sources of support in the later stages of life. They expressed concerns about having only one or two children. The fear is that a small number of children may not be sufficient to provide support in old age, take care of health, or ensure necessities such as food. The desire for a son is tied to the belief that only a male child can ensure the continuity of the family lineage and provide support in old age, as highlighted in the provided quotes. “ If I give birth to a girl’s child, then the girl will become older, she will take care of our health in old age, the boys will leave us after getting married, and the girls will not”. (FGD, Upper Bonda) “ When my daughter (ankui da/Toki) gets married, we will get “Jalla” (Bride price) from the groom’s (umpar/munus ghar) house. The girl will do both the work financial support and old age support”. (FGDs, Upper Bonda and Lower Bonda, 41 years) “ If more girls are born, then we will get more income in terms of the Bride price; if a boy child is born, then we will get old age support (Dokra dokri wo kiang beyita)”. (IDI, Upper Bonda) “ My husband wants a boy child, I have five girls children since we need one boy child because of our future generation, and if my daughter gets married, she will go to another house who will take responsibility for our wealth and our health; that’s why I am not adopting any contraceptive for the hope of boy child and for the tension of boy child, my husband got always drunk”. (IDI, Lower and Upper Bonda) The Bonda people emphasized that as more children are born, they will receive additional help, financial help, and old age support. “If we have one or two children, then they will not survive in the future; who will give support to our old age? Who will take care of our health, who will give us food”. (FGDs, Upper Bonda, 35 years) Subthemes (II): Challenges in Contraception among Bonda Husbands: Unraveling Societal Dynamics Bonda husbands reject contraceptive methods due to male dominance in their society, where men's decisions are superior. Existence, including biological needs and sexual desires, is crucial. Both Bonda women and men fear losing partners, leading to observed sexual promiscuity. Historical practices, such as polygamy, play a crucial role in shaping attitudes toward contraceptive methods. Several reasons contribute to the unwillingness of Bonda husbands to adopt contraceptive methods. A lack of awareness about contraceptive options is prevalent, as education and information dissemination may not be prioritized. Additionally, there may be concerns about reduced sexual enjoyment, economic implications, and negative health impacts associated with contraceptive use. The challenge of contraceptive methods among Bonda husbands is deeply rooted in the cultural and historical context of their society. Addressing these challenges would likely require a comprehensive approach, including education, awareness campaigns, and a shift in societal norms, to encourage more open discussions about family planning and reproductive health. Work prioritization over health is influenced by low socioeconomic status, and individuals rely on production and a subsistence economy. Bonda men worry that contraception's side effects will hamper agricultural activities, resulting in decreased household productivity. Furthermore, the study identified side effects and a lack of husband/family support as factors that may contribute to the discontinuation of contraceptives. Some of the quotes are described in the following section. “ Husbands do not allow their wives to do family planning because they do not know anything about family planning, because husbands do not go to attend meetings where health workers talk about health care, pregnancy, and family planning practices. Side effects can harm their socioeconomic activities”. (Key informants) “ My husband opposes family planning methods because he thinks that if a woman chooses family planning, he will be unable to enjoy sexual desires ”. (FGDs, Lower Bonda) “ My husband refused to do this because it has many side effects on health due to this; we are not able to do household work ”. (FGDs, lower/upper Bonda) “Selangeng to one woman in FGD, the fear of losing their wives the male members believe that if women use Female Sterilization, they will stop having children and look young (selange, change) and healthy. If their women appear healthy and attractive, then the other male member will capture the women”. (FGDs, Lower Bonda) “ If I use the contraceptive method, then I will become ill, due to my illness, my husband will marry another woman. Because they will have reason to say you are unable to perform any household work because of health issues”. (Upper Bonda, FGD) 4-Perception of healthcare providers Subtheme (I) - Resistance faced by health workers while providing counseling/services. According to ANM/Asha, there was a lack of awareness programs, educational communication, or initiatives to increase women’s knowledge of contraceptives. The Bonda believed that healthcare professionals often mislead us by providing only partial information. Because of illiteracy and lack of suitable promotions of contraceptives by healthcare professionals, many women lack awareness about contraceptives. If a healthcare provider comes to create awareness, then there is no road to reach each village, and there are no proper conditions for such quarters to stay there. That’s health workers would face many such things that’s why they stay in the city area and would not be able to do their job properly. The absence of government-sponsored information, awareness programs, educational communication, or initiatives dedicated to enhancing women's knowledge of contraceptives, as reported by auxiliary nurse midwives (ANMs), emphasizes a significant gap in reproductive health services for the Bonda community. The need for targeted educational efforts contributes to a critical information deficit, hampering informed decision-making regarding reproductive health within the Bonda population. Addressing these gaps through comprehensive and culturally sensitive reproductive health programs is crucial for empowering women with accurate information and adopting a better understanding of contraceptive options. There are some women who listen to teachers, Anganwadi, Asha and they come for pills but take them for one day, forget them the next day and drink alcohol or go somewhere for work, then forget them completely the next day. If they have taken medicine, they do not maintain the calendar properly; that is why even after taking medicine, some of them suffer. (IDI from Doctor, Pharmacist, ANM/Health Care Professionals) Both recipients of healthcare services and healthcare providers often lack awareness of government plans and policies. When Bonda women use pills, they may not follow to proper usage, neglect adequate rest, consume alcohol daily, or fail to maintain a nutritious diet, resulting in weakness and dizziness. Discussion This study undertook a qualitative investigation to gain a comprehensive understanding of the barriers hampering the adoption of modern family planning (FP) methods, as well as the barriers/challenges related to contraceptive usage, the management of unwanted pregnancies, and the spacing between children among the Bonda tribe of the hill pockets of the Eastern Ghats Mountain Range located in the Malkangiri district of Odisha, India. These findings reveal several reasons for the existence of barriers to and discontinuation of contraceptive usage. The current study highlights a notably low prevalence rate of contraceptive use among the Bonda community, especially concerning temporary methods employed by males, which are nearly nonexistent. While most individuals in the region are familiar with at least three types of family planning (FP) methods, there is a gap in preparedness for future use or guidance from others. Despite awareness of modern contraceptives, a limited percentage of women possess knowledge about family planning methods, as evidenced by previous studies (Swamy et al., 2017) (Mishra et al., 2017 ), (Ochako et al., 2018 ), (Palo et al., 2020 ), (Mushy et al., 2020 ), and (Sowmya et al., 2020), (Sekine et al., 2021 ). (Prusty, 2014 ) reported that even though tribal women were aware of FP methods in Jharkhand, only 17% utilized any modern contraception, in contrast to 39% of nontribal women. (Dansereau et al., 2017 ) found that even when women were aware of family planning methods, they often lacked comprehensive information about them, indicating a gap in understanding and access to detailed information on various contraceptive options. This deficiency in knowledge persists despite their awareness. This lack of awareness and knowledge underscores the importance of improving education and communication regarding available family planning services, particularly emphasizing the accessibility and cost-free nature of these services at public healthcare facilities. Enhancing awareness can contribute to informed decision-making and increased utilization of family planning services among married adolescent girls. (Jhariya et al., 2013 ) indicated that among the Baiga community in Madhya Pradesh, 46% of couples were identified as users of contraception, while 54% were classified as nonusers. This finding suggested a diverse range of family planning practices within the Baiga community in Madhya Pradesh, with slightly less than half of the couples actively utilizing contraception. (Mushy et al., 2020 ) studied Tanzania, and reported that all participants were aware of modern family planning (FP) methods. A majority of participants exhibited knowledge by listing various contraceptives and explaining their mechanisms. This indicates a generally high level of awareness and understanding among the participants, reflecting positively on the study. Most participants in the studied area indicated that they had undergone an unconsented contraceptive procedure, which was an unusual practice in previous Indian studies. This practice is aimed at spacing childbirths and for the financial purpose of health workers. This unauthorized use of contraception has resulted in side effects that adversely affect the household economy, physical health, and mental well-being, placing unnecessary pressure on women to discontinue the method. The research also identified grassroots-level workers as the primary barriers to mistrust, access, or discontinuation of future contraception. The study findings indicate the occurrence of violent professional behavior in which the provider does not ask for consent or inadequate communication among the participants related to health procedures, and some of the studies have investigated related topics (Mwasha et al., 2023 ), (Nanvubya et al., 2020 ). The primary reason Bonda women stopped using contraceptive methods was the occurrence of side effects. The study revealed that various side effects, including foul-smelling discharge, severe white discharge, fear of fertility issues, back pain, weakness, dizziness, and irregular menstruation, were major contributors to the discontinuation of contraceptive use among the Bonda tribe. Similarly, findings from other studies at the international level widely reported the side effects of contraceptives, viz., men expressed frustration with side effects, irregular and prolonged bleeding, dryness in the vaginal area, declines in sexual desire, concern about physical health, side effects and fear of long-term impacts. Irregular menstrual cycles, dizziness, headaches, stomachaches, weight gain, and weight loss are among the most commonly reported side effects associated with various contraceptive methods (Carter et al., 2012 ) (Kabagenyi et al., 2014 ), (Ajayi et al., 2016 ),(Swamy et al., 2017), (Dansereau et al., 2017 ) (Rios-Zertuche et al., 2017 ), (Ochako et al., 2018 ), (Silumbwe et al., 2018 ), (Mushy et al., 2020 ). Similarly, at the national level, studies have been conducted (Hall et al., 2008 ), (Rustagi et al., 2010 ), (Bhattathiry & Ethirajan, 2014 ) (Mishra et al., 2017 ), (Manna et al., 2019 ), (Sowmya et al., 2020), (Sekine et al., 2021 ), (Jain et al., 2021 ). Various myths about copper T, such as displacement into the abdomen causing cancer, fear of fertility issues, shortage of milk, irregular menstruation, and reduced earning capacity, further act as barriers. These misconceptions stem from unsuitable information received from friends, relatives, and husbands. In this context, similar findings on myths and misconceptions as barriers to contraceptive use are documented in such studies (Adongo et al., 2013 ) (Ochako et al., 2015 ), (Mishra et al., 2017 ), (Hameed & Avan, 2018 ), (Palo et al., 2020 ) studied PVTGs of Odisha in the Keonjhar district and revealed that women in the study area expressed strong barriers toward permanent sterilization due to a cultural belief that undergoing such a procedure would prohibit them from participating in worship practices associated with their religion or belief system. The present study states that myths and misconceptions create the primary barriers preventing Bonda women from using contraceptive methods, as adopting family planning methods hampers their ability to work in strenuous labor. Furthermore, this study revealed that family pressure and a lack of spousal support play significant roles in preventing women from adopting contraceptive methods. Similar findings were observed in the study by (Rustagi et al., 2010 ), where many participants hesitated to use contraceptives without their partner's consent, and familial pressure to have more children emerged as a major obstacle to contraceptive avoidance. Interestingly, the Bonda tribe shows a strong preference for having daughters after marriage, expressing a keen desire for pregnancy and a preference for female children. The study revealed that having more female children is associated with an increase in the bride price received by the parental household, which is associated with a similar observation in the Keonjhar district of Odisha (Palo et al., 2020 ). Simultaneously, the Bonda equally valued male children as economic assets. This highlights the inclination of the Bonda community toward larger families, as they believe it leads to more children, increased income, and additional assistance in household activities, particularly in agriculture and slash cultivation. Contrary to these findings, (Rustagi et al., 2010 ) observed inconsistent findings in a minority community in Delhi, where the majority of women agreed that a large family size is undesirable due to its association with a lower quality of life, increased expenditures, and a decline in women's health. Like a qualitative study conducted by (Kabagenyi et al., 2014 ) in two rural districts in Uganda, a preference for large families was noted, as a symbol of wealth and financial security. Additionally, in Rajasthan, there is a cultural need for a large number of sons according to (Singh & Srinivasan, 2000 ), and in Gujarat (Kumar & Joshi, 2008 ) and West Bengal (Manna et al., 2019 ), cultural perspectives influence family size. Research conducted in Uganda highlighted a lack of male involvement in family planning (Kabagenyi et al., 2014 ). In southern Ghana (Adongo et al., 2013 ), as well as in the study by (Davis et al., 2016 ), there was unanimous agreement on the benefits of involving men in family planning and maternal and child health (MCH), as it was found to increase the utilization of family planning services. According to the study, shyness in discussing contraceptive use with spouses and healthcare providers serves as another barrier to the discontinuation of contraceptive methods. Participants lacked the awareness and autonomy to communicate effectively with their partners and healthcare professionals. Unfamiliarity with healthcare providers and contraceptive methods left participants unable to make decisions about using contraceptives, as they relied on others to make these choices. This finding is consistent with a study conducted in Nepal's Bara district (Sekine et al., 2021 ), where adolescent girls exhibited shyness in discussing contraception and childbearing. Conclusions The primary barriers to the discontinuation of modern contraceptive methods among the Bonda tribe in Malkangiri district, Odisha, include limited knowledge and awareness about modern contraceptive methods hampering their consistent use, deep-rooted cultural beliefs and traditional perceptions surrounding family planning contribute to resistance or discontinuation, procedures carried out without the individual's consent may lead to mistrust and discontinuation of contraceptive methods, side effects; myths and misconceptions, family/husband mindsets, gender preferences/economic influence, and lack of government-sponsored initiatives. These are the barriers collectively play a significant role in influencing the discontinuation of modern contraceptive methods, emphasizing the need for targeted interventions and awareness campaigns to address these challenges. Research implications. These findings suggest the need for targeted policy interventions aimed at educating both men and women about FP methods. Ensuring easy access to health care services for women experiencing side effects. The study also highlights ethical and legal concerns related to medical procedures and informed consent. Addressing limited housing options for healthcare professionals is crucial for ensuring accessible and timely medical care. This will involve collaboration between healthcare institutions, local authorities, and relevant participants to improve living conditions for healthcare providers. Addressing such misconceptions is necessary for promoting informed and empowered reproductive health choices among Bonda women. Education and awareness programs that dismiss myths and provide accurate information about family planning methods can play a crucial role in helping individuals adopt a supportive environment for reproductive health decisions within the community. This research underscores the necessity of targeted policy measures to educate both genders on family planning (FP) methods. These findings emphasize the importance of facilitating women's access to healthcare services to manage side effects effectively. Additionally, the study identified ethical and legal issues surrounding medical procedures and provided informed consent. The crucial need to improve housing options for healthcare professionals to ensure timely medical care is emphasized, requiring collaboration among healthcare institutions, local authorities, and relevant stakeholders. Overcoming misconceptions is vital for informed reproductive health choices among Bonda women. Education programs dispelling myths and offering accurate information on FP methods are key to fostering a supportive community environment for reproductive decisions. Limitations Women who met the inclusion criteria were selected using purposive sampling. The study's limitations include the use of a small sample size and the lack of use of software for analyzing qualitative data. Declarations Conflict of interest statement The Author(s) declares that there are no conflicts of interest. Funding Details This work was supported by the National Fellowship and Scholarship for Higher Education of ST Students (NFST), New Delhi, India, vide Ref. No: 201819-NFST-ODI-02326. Author Contribution 1-Ranjita Nayak- She conceptualized and selected the paper's title and also acquired ethical approval, ensuring that the research followed ethical guidelines. Ranjita Nayak undertook significant fieldwork, obtaining primary data for the study. She thoroughly analyzed the acquired data with her knowledge and contributed significantly to the paper's writing, providing unique insights and interpretations.2-Sonia Kaushal contributed significantly to the paper's methodology portion. Her suggestions for organizing and improving the research techniques improved the study's overall quality and reliability. In addition, Sonia Kaushal had responsibility for editing the entire document, guaranteeing clarity, consistency, and conformity to academic guidelines. Her careful editing and framing substantially enhanced the paper's appearance and readability.3- A.N. Sharma- A.N. Sharma was involved in the early stages of the research endeavor. He identified the precise area of study and sampling process. Acknowledgments We extend sincere gratitude to our study participants for their valuable time and cooperation in responding to our inquiries. Special thanks are extended to the administrative and ethical approval of the Institutional Ethical Committee, IEC Approval vides letter number: DHSGV/IEC/2022/05 of Dr. Harisingh Gour Vishwavidyalaya, Sagar, M.P. (India). We express our gratitude to all the governmental bodies of Malkangiri district, Odisha, India, for granting permission to conduct the research. Their collaboration significantly contributed to the success of our research endeavor. Sincere thanks also go to the National Fellowship and Scholarship for Higher Education of ST Students (NFST), New Delhi, India, for financial support in terms of fellowship vide Ref. No: 201819-NFST-ODI-02326. Availability of Data The data that support the findings of this study are available from the corresponding author upon reasonable request. The study data pertains to one of the marginalised tribal groups in India and contains sensitive information. Therefore, to protect the integrity and privacy of the respondents, and as per the ethical guidelines, the data is restricted and cannot be made public. References AB Ota, S. C. M. (2007). Scheduled Castes & Scheduled Tribes Research and Training Institute (SCSTRTI) Bhubaneswar - 751003. 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A qualitative study on determinants of choice of contraceptives in a rural. International Journal Of Community Medicine And Public Health , 4 (6), 1943. https://doi.org/10.18203/2394-6040.ijcmph20172154 UNDESA. (2022). World Family Planning. In the United Nations . https://www.un.org/en/development/desa/population/publications/pdf/family/WFP2017_Highlights.pdf Verrier Elwin. (1950). Bondo-highlander by Varrier Elwin. In BOOK . WHO. (2007). Standards for Maternal and Neonatal Care. WHO Library , 1–72. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3940688","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":274051185,"identity":"176689dc-cb8e-4c03-a60a-e66501e43414","order_by":0,"name":"Ranjita Nayak","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABFUlEQVRIiWNgGAWjYJACgwQIzcz4oUJCDsQ68ICgFogeZmaJMzbGYC0JBO2BamHgbUtLbEAIYAfm7WcPFDz8YZfHPyP5sYFk2+H0+WGHHwJtsZPTbcCuReZMXgLQYcnFEjfSjBMKzh3O3Xg7zQCoJdnY7AB2LRIMOQZALcyJDTcSjA9IlAG1zE4AaTmQuA2XFv43IC31ifNvpH8+wMN2ON1wdvoH/FokwLYcTtxwI8c4gactLUFeOoeALRIgW9KOJ24886bYGBjIhhukcwoOJBjg8Qt/jpnhD5vqxHnH0zdLAqNSXn52+uYPHyrs5HBpAQI2AzAlkADhGoBVGuBUDgLMD8AUP9RQ+Qa8qkfBKBgFo2AEAgAlSWaPo3wg6QAAAABJRU5ErkJggg==","orcid":"","institution":"Dr. Harisingh Gour Vishwavidyalaya, Sagar,M.P.","correspondingAuthor":true,"prefix":"","firstName":"Ranjita","middleName":"","lastName":"Nayak","suffix":""},{"id":274051186,"identity":"bb408017-da92-446d-a9c3-900d90722f29","order_by":1,"name":"Sonia Kaushal","email":"","orcid":"","institution":"Dr. Harisingh Gour Vishwavidyalaya, Sagar,M.P.","correspondingAuthor":false,"prefix":"","firstName":"Sonia","middleName":"","lastName":"Kaushal","suffix":""},{"id":274051188,"identity":"e520ce24-1611-4a77-a10d-31a04b82d621","order_by":2,"name":"A.N. Sharma","email":"","orcid":"","institution":"Dr. Harisingh Gour Vishwavidyalaya, Sagar,M.P.","correspondingAuthor":false,"prefix":"","firstName":"A.N.","middleName":"","lastName":"Sharma","suffix":""}],"badges":[],"createdAt":"2024-02-08 17:29:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3940688/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3940688/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":65587685,"identity":"95a7c606-3a4a-4052-8b97-6ac9847288ba","added_by":"auto","created_at":"2024-09-30 09:24:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1175074,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3940688/v1/550fa78c-93bd-42ea-8e79-eb72a672c075.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Challenges in Modern Contraception Access among Married Bonda Women: Insights from a Qualitative Study on Family Planning Barriers and Healthcare Dynamics","fulltext":[{"header":"Introduction","content":"\u003cp\u003eFamily planning (FP) plays a critical role in the progress of any nation through human development. FP refers to a way of living, thinking, and making responsible decisions voluntarily by individuals and couples, based on knowledge and attitudes (WHO, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2007\u003c/span\u003e). Along with contraceptive use, FP covers different means such as information, policies, attitudes, services, commodities, and practices, that help to generate the ability of couples, adolescents, and men/women to avoid unplanned conception as well as when and whether they schedule having progeny (Starbird et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). FP and contraceptive programmes help to control population growth and tend to positively affect different socioeconomic factors, such as enhancement of the opportunity for education, a decrease in poverty levels, and promotion of gender equality (Danton, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). Likewise, these practices offer the prospect of enhancing maternal and child health, through the avoidance of early and unwanted gestations, risky abortions, and the inhibition of different sexually transmitted diseases (STIs) (Hubacher et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2008\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTo achieve sustainable development goals (SDGs), the UN has prioritized the increase and utilization of FP and contraceptive use services in a sustainable way as one of its distinguished strategic investment emphasis agendas (Starbird et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). By 2030, individuals will achieve the target of collective access to sexual and reproductive health (SRH)-related services, together with FP, information, and education, through the use of different FP/contraceptive service-related programs at the community and national levels (Buse \u0026amp; Hawkes, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Globally, different services/programmes related to FPs/contraceptives play key roles in promoting and increasing the frequency of contraceptive practices at the community level. Despite this, the acceptance of FP/contraceptive methods/services is still low in several worldwide pockets, including Asian and Latin American countries, and remains the least common statistic in sub-Saharan regions of the African continents (Moreland \u0026amp; Talbird, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2006\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eUN\u0026rsquo;s report on FP mentioned that globally as well as regionally, the share of women who adopted any contraceptive methods to avoid unintended pregnancy is comparatively maximum among women between the age group of 25 to 44 years, contrastingly reported lowermost among women of age group below the age 25(UNDESA, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Worldwide, among the 1.9\u0026nbsp;billion (15\u0026ndash;49 years) women, 966\u0026nbsp;million who use any contraception methods are categorized as 874\u0026nbsp;million who have adopted a modern method and 92\u0026nbsp;million who have adopted a traditional contraceptive method (UNDESA, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). The National Family Health Survey 5 (NFHS-5), which was conducted between 2019 and 2021, reported that 53% of tribal married women in India use any modern contraceptive practices (i.e., below the national average), where more than 80% of the users receive FP-related information from health workers as well as from public health facilities (Panda et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOn the one hand, the FP is often described as an issue related to women, but men influence family planning choices; on the other hand, in major cases, women and men both know about different commonly used family planning practices, but still, they do not understand them entirely (Dansereau et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Different studies across the globe have highlighted the factors/barricades associated with the rate of acceptance and refusal of FPs and/or the use of contraception methods as their choices, viz. ethnicity, maternal education, age, individual perceptions, marriage, number of pregnancies, delivery location, household wealth, insurance status, receiving guidance/advice from a health care provider, unavailability of the ideal method/trained personnel for FP, the decision-making power of the female, fear of method\u0026rsquo;s side effects, myths/misconceptions, discouragement from intimate partner/closest friends, cultural opposition and religious perception(Dansereau et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2017\u003c/span\u003e),(Nazar-Beutelspacher et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e1999\u003c/span\u003e), (Estrada et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2008\u003c/span\u003e), (Darney et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2016\u003c/span\u003e), (Rios-Zertuche et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), (Abdi et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), (Mushy et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) but not limited to these. Various similar studies have also been reported on the Indian subcontinent among different population groups, including tribal populations (Panda et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), (Hall et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2008\u003c/span\u003e), (Ghule et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), (Palo et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), (Sowmya et al., 2020), (Shewale \u0026amp; Sahay, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA review of the literature reveals that barriers to the acceptance and use of modern FP methods and contraceptive use are still found at low utilization levels and are very unsatisfying among tribal populations; moreover, even a number of microlevel community-based studies have not been performed in diverse socioenvironmental settings. To fill this gap, the present study involved a qualitative investigation to obtain an in-depth understanding of the existing barriers to modern FP, contraceptive use, the management of unwanted pregnancies, and the spacing between two children among the Bonda, a particular vulnerable tribe group (PVTG), which is confined to the restricted hill pockets of the Eastern Ghats Mountain Range located in the Malkangiri district of Odisha, India. Simultaneously, how health care providers, specifically mothers/mothers-in-law and husbands within the family, influence Bonda women's FP practices was explored.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy setting, study subjects, and sample size\u003c/h2\u003e \u003cp\u003eFor this study, the Malkangiri district of Odisha was purposively selected. Malkangiri is situated in the southern part of the state of Odisha. The eastern portion of the Malkangiri district of Odisha state is sparsely inhabited by different primitive tribes, distinguished by 02 particular vulnerable tribal groups (PVTGs), viz. Bondas and Didayis, along with Koyas and Porajas (About District Malkangiri, Government of Odisha, 2023). The present qualitative explorative study was conducted among the eligible married couples of Bonda PVTGs as well as health workers and other government officials in the region of interest between December 2021 and July 2022 in the Khairput block of the Malkangiri district, Odisha, located in the lining of the Kondakamberu Range of Eastern Ghats (AB Ota, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2007\u003c/span\u003e). In the emic nomenclature, they knew themselves as \u0026lsquo;\u003cem\u003eRemo\u003c/em\u003e\u0026rsquo;, or \u0026lsquo;\u003cem\u003ePeople\u003c/em\u003e\u0026rsquo; (Verrier Elwin, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e1950\u003c/span\u003e), where two social divisions \u003cem\u003eexist\u0026mdash;\u0026lsquo;Gor Remo\u003c/em\u003e\u0026rsquo; and \u0026lsquo;\u003cem\u003eJanga Remo\u0026rsquo; (the\u003c/em\u003e mother tongue of Bonda\u003cem\u003e)\u003c/em\u003e \u0026lsquo;Talar Bonda\u0026rsquo; and \u0026lsquo;Upar Bonda\u0026rsquo; (a widely speaking native language) \u0026lsquo;\u003cem\u003elower\u0026rsquo;\u003c/em\u003e and \u0026lsquo;\u003cem\u003eupper\u0026rsquo;\u003c/em\u003e Bonda (English) among them and their livelihood moves around subsistence type extensive step cultivation, forest collection, and minor hunting.\u003c/p\u003e \u003cp\u003eThis study aimed to investigate the reproductive health of women from both the lower and upper Bonda tribes. The research utilized a stratified random sampling approach to select participants from villages, with a focus on areas with established CHCs/PHCs/SHCs as centers. Five specific Gram Panchayats (GPs), Kadamguda, Rasbeda, Khairput, Mudulipada, and Andrahal, were chosen due to their significant Bonda population. Participants were selected through a purposive sampling approach, where villages were chosen randomly. The study targeted married Bonda women aged 15\u0026ndash;49 years from both the lower and upper Bonda. A total of 69 participants (26 from Lower Bonda and 43 from Upper Bonda) participated in the study, with 8\u0026ndash;9 partakers in each FGD group. Likewise, 07 in-depth interviews (IDIs) (04 among Lower Bonda and 03 among Upper Bonda) were conducted among Bonda married female participants (15\u0026ndash;49 years), and 16 IDIs were conducted with local health care providers, teachers, postmasters, and businessmen at the locality.\u003c/p\u003e \u003cp\u003eThe first FGDs and IDIs included participants from both younger and older age groups (15\u0026ndash;49 years) to ensure diverse perspectives. This approach aimed to provide all participants with the opportunity to share their opinions without feeling any pressure. Second, IDIs were conducted with medical staff, including Doctor, Pharmacist, ANMs, and Asha/Anganwadi (AW) workers working in the study area. Third, female postmasters, female teachers, and local businessmen/women were asked about the IDIs.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eInclusion criteria and selection of study participants\u003c/h2\u003e \u003cp\u003eIn this study, the participants involved were married women belonging to the Bonda PVTG group aged between 15 and 49 years who had given birth to one or more children. The participants were selected based on their age and history of contraceptive use. Likewise, the local health care providers, appointed by the government and nongovernment, viz. ASHA, Anganwadi Workers (AW), Female Attendants of the Health and Wellness Centre, Auxiliary Nurse Midwives (ANM), Pharmacists, and Doctors were interviewed. Other key informants, such as female postmasters, female teachers, and local businessmen/women, were also asked.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eMethod of data collection\u003c/h2\u003e \u003cp\u003eAs in the tribal context, the FP is a very sensitive issue; during the FGD, the study participants were grouped according to their education, profession, and age. Similarly, the married women were identified from the updated records kept by the AW and ASHA from different small villages and hamlets. The investigator conducted interactions with married women in either the \u003cem\u003eRemo Sam\u003c/em\u003e dialect (the mother tongue of Bonda) or Desia (a widely speaking native language) in the Odia language with health workers and key informants. The data were collected via a qualitative approach (with FGD and IDI) through different pretested semi structured interview schedules. Here, the duration of IDI was approximately 20\u0026ndash;45 min, whereas the duration of FGD was 60\u0026ndash;90 minutes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eEthical consideration\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eEthical approval\u003c/strong\u003e \u003cp\u003e for the study was obtained from the Institutional Ethics Committee at Dr. Harisingh Gour Vishwavidyalaya, Sagar-470003, M.P., India; the letter number is DHSGV/IEC/2022/05. Before their involvement in the study, all the volunteer participants were informed about the study purpose, privacy, advantages, and risks involved in the research, and written informed consent was obtained from all participants through signatures or thumb impressions where they were illiterate. Informed consent was obtained from the female volunteer participants younger than 18 years after receiving consent from their spouse.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData Analyses\u003c/h2\u003e \u003cp\u003eBraun and Clark\u0026rsquo;s thematic content analysis techniques were applied. All the FGDs and IDIs were either audio recorded or noted in the field diary of the researcher, and the data collected from the FGDs, IDIs, and key informants were transcribed verbatim and translated into Odia to English. The English-translated stories were then typed into a word processor for data analysis so that the data could be easily analyzed. First and foremost, the researcher became acquainted with the data by reading and rereading the narrative stories. After that, the studies were coded manually and in order. Afterwards, the studies were listed, sorted, excluded, combined, and subcategorized, and examined for associations between them and logical analysis. The topics were cross-checked for validity and accuracy before being reviewed. In the final step, the themes and subthemes were defined, and their names were written. The research questions and objectives of the study determined how subthemes and themes would be generated from the codes (Table no.3).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eSocio-demographic characteristics of key informants\u003c/h2\u003e \u003cp\u003e \u003cb\u003eTable no.1 (n\u0026thinsp;=\u0026thinsp;16)\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAsha/Anganwadi n\u0026thinsp;=\u0026thinsp;07\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eANM/Female attendant n\u0026thinsp;=\u0026thinsp;03\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDoctor/pharmacist n\u0026thinsp;=\u0026thinsp;02\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAdministrators n\u0026thinsp;=\u0026thinsp;04\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eAge in years\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e40\u0026ndash;49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWidowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eParticipants Description\u003c/h2\u003e \u003cp\u003e \u003cb\u003eTable no.2: Participants description (n\u0026thinsp;=\u0026thinsp;69)\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency (N\u0026thinsp;=\u0026thinsp;69)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eAge group\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e31\u0026ndash;49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiddle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigher Secondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLocation of the study\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLower Bonda\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUpper Bonda\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHome Maker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eForestry\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAgriculture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePvt. Job/Business\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTeacher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNo. of children\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u0026ndash;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e02\u0026ndash;03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e04\u0026ndash;05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eName of the contraceptives used\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePill\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCopper-T\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCondom\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale Sterilization\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot used anything\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe study involved a total of 69 women from the Malkangiri district of Odisha. The participants came from lower socioeconomic backgrounds, indicating that they may have faced economic challenges or belonged to lower-income households. Most of the women in the study area worked in the fields of forestry and agriculture. The profile of the study group was predominantly composed of women aged 31 to 49 years. More than half of the women in the study had no formal education. Most of the women in the study had two or three children. All the Asha/Anganwadi individuals were female, all were from the Bonda tribe, the ANMs were in other groups, and most were younger than 35 years. The doctor and pharmacist were male and aged less than 50 years (Table no. 2).\u003c/p\u003e \u003cp\u003eTo identify the causes of misconceptions and barriers and design preventative measures, it is important to investigate the viewpoints of women and healthcare professionals regarding modern family planning methods during the period of reproduction. In a broader discussion of family planning obstacles, Bonda women voice strong objections to nonuse and prevent others from giving it a second thought. However, taking a deeper look at the acceptability of and obstacles to the use of contemporary contraceptives in specific circumstances reveals slight variations that are thoroughly examined in this paper. The study examines the accessibility for women and providers, the hurdles confronted by Bonda women, and the responses of participants who have experienced such challenges. Four main themes and nine subthemes were identified from the data, viz. 1) Awareness and practices of FP methods, 2) access barrier to reproductive health services, 3) cultural and societal expectations related to gender roles and family dynamics within the Bonda community, and 4) perceptions of healthcare providers. The findings are presented with quotes from the participants under each theme and subtheme (Table No. 3).\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable no.3 Presents the major themes, sub-themes, and codes.\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabc\" border=\"1\"\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMain Themes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSub themes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCodes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1. Awareness and practices of FP methods\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(I) Disparities in Contraceptive Knowledge among Bonda women: a comparative analysis and Source of Information\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale sterilization, copper-T, Pills, condoms, and Antara, Asha/Anganwadi/ANM, spouses, and friends\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(II) Traditional perception and cultural barriers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUncomfortable/shy learning, timing of meeting, ashamed to attend meeting, spoke nonsense\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e2. Access Barrier to Reproductive Health Services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(I) Unconsented Contraceptive procedures and Reproductive Health Complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHealth issues, Healthcare provider insert Copper-T without consent, Doctor were not available, left without proper stich\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(II) Side Effects and Refused to accept\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSide effect of Copper-T on health, never ask anyone to use it\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(III) Navigating Myths and Barriers: Bonda Women and Contraceptive Misconceptions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUsed copper-T Lead to cancer, will melt inside the Body, Unable heavy lifting, unable to climb mountains, long gap of have conceived, shortage of milk\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(IV) Factor influencing contraceptive decision.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHusband/Mother-in-law, safety of child, physical violence\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e3. Cultural and Societal Expectations related to gender roles and family dynamics within the Bonda community\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(I) Gender preference, Economic Influences, and Future Support Concerns\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGirl child, Boy child, financial and old age support, Jalla (Bride price)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(II) Challenges in Contraceptive Among Bonda Husbands: Unravelling Societal Dynamics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHusband does not allow wives, husband opposes, sexual desire, fear of losing, Healthy and attractive, capture women, marry another woman\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4. Perceptions of healthcare providers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI) Resistance faced by the health workers while giving counseling/services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLack of awareness programs, mislead, partially giving information, neglect adequate rest, drinking alcohol\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe results presented below explain the experiences of married Bonda women during contraceptive access, highlighted the impact of personal and cultural factors on the use and discontinuation of contraceptive methods.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eTheme:1-Awareness and practice of family planning methods\u003c/h2\u003e \u003cp\u003e \u003cb\u003eSubthemes: (I) Disparities in Contraceptive Knowledge among Bonda Women: a Comparative Analysis and Source of Information\u003c/b\u003e \u003c/p\u003e \u003cp\u003eParticipants in the study demonstrated varying levels of knowledge regarding contraceptive methods, with some possessing awareness of at least one method. In contrast, others remained uninformed and were not motivated to consider contraception in the future. The disparity in knowledge among Bonda women residing in upper and lower regions was remarkable.\u003c/p\u003e \u003cp\u003eLower Bonda women who resided on hill slopes and had more connections with mainstream society had a greater awareness of contraceptive methods. Patients in this group were more likely to use alternative contraceptive methods for female sterilization or copper-T as a means of birth control. The increased exposure to external influences contributed to a better understanding of the significance of contraceptives among these lower Bonda women.\u003c/p\u003e \u003cp\u003eOn the other hand, upper Bonda women, isolated in hilly regions with limited access to external groups and media, lacked sufficient knowledge about birth control methods. The geographical exclusion of this group caught up with their exposure to information regarding contraception options.\u003c/p\u003e \u003cp\u003eAmong the contraceptive methods known by both groups were female sterilization, copper-T, contraceptive pills, condoms, and Antara. These methods represent a shared baseline of knowledge, though with differences in prevalence and adoption option rates.\u003c/p\u003e \u003cp\u003ePrimary sources of information for women in both groups included Asha/Anganwadi/ANM, spouses, and peer groups. These media played a crucial role in spreading information about contraceptive methods and influencing women\u0026rsquo;s decisions regarding FP.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eSubtheme: (II) Traditional Perception and Cultural Barriers\u003c/h2\u003e \u003cp\u003eAccording to the Bonda women, the practice of having children annually is observed as indicative of a healthy mother contributing to a positive social identity and supporting the traditional role of motherhood. This perspective is rooted in the belief that each child is considered a divine gift to the family.\u003c/p\u003e \u003cp\u003eThe Bonda people express shyness during such discussions, reflecting their deep attachment to traditional cultural norms. The persistent prevalence of historical practices makes it challenging for them to willingly adopt modern contraceptive methods, leading to difficulties in education on family planning methods.\u003c/p\u003e \u003cp\u003eSeveral barriers contribute to the hesitancy of Bonda women to adopt modern contraceptive methods. These include the cultural shyness surrounding discussions about contraceptives with spouses and healthcare staff, challenges related to the timing of meetings, and the constant observance of cultural norms and values. These factors collectively restrain the acceptance of contemporary FP practices within the Bonda community. The following quotes support these points.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Bonda women are unwilling to attend Anganwadi and VHND meetings because they are uncomfortable/shy learning about contraceptive methods and their uses. They think that if they go to attend meetings, then their work will stop; hence, half of them will not come to the meetings. In addition, yes, one good thing from the government happened: those who attend VHND meetings and antenatal care get nutritional food; due to this, some prefer to attend meetings, and some of them do not\u0026rdquo;.\u003c/em\u003e \u003cb\u003e(Interview, Asha/Anganwadi)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;When I go to call mothers to attend the VHND meeting, she told me I can\u0026rsquo;t come, I have work today, I have work to go here and there, and if I come to the meeting who will do our work? If you are giving something, then give it to my daughter or my neighbors. I will come and collect it in the evening\u0026rdquo;.\u003c/em\u003e \u003cb\u003e(IDI, Asha/Anganwadi)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;The Bonda women were opinionated; the healthcare provider spoke nonsense about contraceptives in the meetings, which we feel were ashamed to attend\u0026rdquo;.\u003c/em\u003e \u003cb\u003e(IDI, Upper/Lower Bonda)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Since the Bondas lack knowledge and are thought to be quite stubborn, teaching them about family planning and spacing methods is very challenging\u003c/em\u003e\u0026rdquo;. \u003cb\u003e(Interview, Key informants)\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eTheme: 2 Access Barriers to Reproductive Health Services\u003c/h2\u003e \u003cdiv id=\"Sec14\" class=\"Section3\"\u003e \u003ch2\u003eSubtheme (I): Unconsented Contraceptive Procedures and Reproductive Health Complications:\u003c/h2\u003e \u003cp\u003eDuring the interview, the researcher noted that the participants were completely helpless in terms of their health.\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eDidi, it has been five to six years, I am not feeling well, I have weakness and dizziness, white discharge and I am not able to eat properly and cannot do any household work. When I gave birth to my third child, this happened to me \u0026hellip;\u0026hellip;. ASHA and the health worker placed Copper-T on my vagina without consent. When I came to know that there was a lockdown, I could not remove it. Earlier, I used to go to Dishari (a traditional healer) regarding my health issue, but I could not overcome it. When the lockdown was opened, I went to CHC three to four times to get this copper-T removed, but always a new problem arose for me\u0026hellip;\u0026hellip;. When I go to the hospital, the doctors were not available at the\u003c/em\u003e hospital\u0026rdquo;. \u003cb\u003e(IDI, Upper Bonda, 38-year, User)\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe use of contraceptive methods has unintended consequences, including a reduction in household productivity and increased medical care costs for women. This not only makes the woman feel like a barrier to the household economy but also affects her physical well-being, reducing her engagement in various activities. Consequently, she struggles to fulfill her responsibilities toward her children and spouse, leading to a negative impact on her mental health. Additionally, limited housing options for healthcare professionals, such as doctors, pharmacists, and ANMs, create accessibility issues, causing inconveniences for patients seeking timely medical assistance. This presents ethical and legal issues because, in general speaking, medical procedures should be carried out only with the patient's informed consent.\u003c/p\u003e \u003cp\u003eFurthermore, the study identified communication gaps between individuals and healthcare providers, occurrences of negligence or violent behavior by health workers, and a lack of spousal awareness as factors influencing reproductive behavior. Husbands who are not familiar with family planning may discourage their spouses from using these services, which is made worse by the reality that spouses are often unaware of family planning information because it is primarily shared with women by healthcare professionals. The following participant quotes highlight these challenges.\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eWithout my consent, Aasha/Health worker inserted a Copper-T and left without a proper stitch after 6 days of delivery. I show that the copper-T was removed automatically\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e(FGD, Upper Bonda, 37-year-old user)\u003c/h2\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;When I gave birth to a boy at CHC, the IUD (Cu-T) was inserted by the health worker, without informing me or my husband. After coming back home, when we get intimate with my husband, my husband noticed the thread was hanging outside the vagina. He asked me what this was and what I did, I told her I didn\u0026rsquo;t know anything about this. In addition, the next morning, immediately, he took me to the hospital. He pressurized the doctor to remove it\u0026rdquo;.\u003c/em\u003e \u003cb\u003e(Interview, Upper Bonda, 32 years)\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe insertion of the IUD (Cu-T) without informing the woman or her husband raises concerns about the lack of proper informed consent. The health worker's failure to communicate the IUD (Cu-T) insertion to the couple led to confusion and concern when they found it during intimate moments. The fact that the husband detected the IUD (Cu-T) thread hanging outside the vagina during intimacy highlights the potential emotional and physical consequences of the lack of communication. The husband felt the need to pressure the doctor to remove the IUD (Cu-T), indicating a breakdown in trust and dissatisfaction with the medical procedure. The incident raises questions about faithfulness to patient rights, as every individual has the right to be informed and involved in decisions about their healthcare.\u003c/p\u003e \u003cp\u003eThis situation emphasizes the need for better patient education regarding contraceptive methods, their potential side effects, and the importance of clear communication between healthcare providers and patients. The incident may lead to quick analysis of healthcare practices to ensure that proper protocols for informed consent are followed to avoid such situations in the future.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;When I delivered my baby in the CHC, the placenta was not delivered. Doctors and nurses entered my vagina area 4 to 5 times and failed to remove it. The CHC Doctor had referred me to the government hospital (Mathili Medical). The doctor successfully removed it by cutting off private parts. The nurse then left some areas without proper stitches, which caused severe bleeding, and the patients were repeatedly stitched. In addition, they used Copper-T on the vagina that was me and my husband without permission. After 3 days, I returned home and noticed that a thread was hanging in my private area. I pulled out the thread, and then the copper-T was removed. I was very afraid of seeing that. Again, I went for the second stitch to the CHC\u0026rdquo;.\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e(IDI, Lower Bonda, 22years)\u003c/h2\u003e \u003cp\u003eThis story sheds attention on the participants\u0026rsquo; difficult pregnancy and delivery experiences as well as the medical issues she faced. The study also revealed the absence of appropriate treatment and consent in the healthcare system.\u003c/p\u003e \u003cp\u003e \u003cb\u003eSubtheme (II): Side effects and refusal to accept.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe study's findings indicate that the main factor leading to the discontinuation of contraceptives, despite a desire to avoid pregnancy, is the occurrence of side effects. Respondents uniformly held the perception that the use of contraceptives could lead to adverse effects such as weakness, dizziness, pelvic pain, and irregular menstruation, indicating a significant concern for their physical health. The prevalent opinion among women is a consistent decision to never repeat contraceptive usage and a strong preference to oppose others from using them, emphasizing a prevalent lack of knowledge about contraceptives. The quotes below provide insights and support these key findings:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Didi, Asha, and the health worker inserted a Copper-T into my vagina. Since that, I have suffered from pelvic pain, dizziness, and a sore smell; often, I get senseless doing some work. In addition, facing irregular menstruation\u0026rdquo;.\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003e(FGD, Upper Bonda, Lower Bonda)\u003c/h2\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eI Got married by elopement in the year 17. At 18 years old, I got pregnant and delivered a baby girl. Asha workers and health workers used copper-T without informing me. I got to know about copper-T after 3 years of delivery. During this period, I was continuously having irregular menstrual bleeding for a long time. I went to the medicine shop and bought some medicine to not bleed. I used medicine for 3 months, and I went for a local medicine man for local medicine. The man gave me Deshi medicine (traditional medicines) after 3 days of eating, at which point the bleeding stopped. However, after that somehow, I knew Copper-T was there, I went to the CHC, and Asked the doctor to remove it\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003e(IDI, Lower Bonda, 24 years)\u003c/h2\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;After my first childbirth, I used copper T, and it felt health problems such as back pain, badly smelling discharge, fear of side effects, and fear of future fertility. I removed it after 6 months of use. Not recommended for future use to anyone\u0026rdquo;.\u003c/em\u003e \u003cb\u003e(IDI, Lower Bonda, 24 years)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I never used it because I feared hearing about the side effects, and I will never use it in my life and will never ask anyone to use it\u0026rdquo;.\u003c/em\u003e \u003cb\u003e(FGD, Lower Bonda)\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eSubtheme (III): Navigating Myths and Barriers: Bonda Women and Contraceptive Misconceptions\u003c/h2\u003e \u003cp\u003eThe Bonda women\u0026rsquo;s views on a prevalent myth that accepting family planning methods would reduce women incapable of performing strenuous work. Residing at a hill station, the Bonda engaged in demanding responsibilities such as labor, slash cultivation, and crop harvesting to secure food for the following day, they did not waste a single day for rest. The lack of prior information and consent for copper-T application results in mistrust and contributes to contraception discontinuation. Myths surrounding Copper-T, such as its displacement into the abdomen causing cancer, concern about fertility, milk shortage, irregular menstruation, and diminished earning capacity, stemmed from misinformation spread by friends, relatives, and husbands. These misconceptions form significant barriers to the adoption of this contraceptive method.\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eAfter using copper T, it will lead to cancer, it will go inside the chest and melt\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003e(FGDs, Lower Bonda)\u003c/h2\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eDidi, if we used it, we would not be able to do the heavy lifting, climb mountains, or lugbur lug (slash cultivation) because it will affect our health in terms of weakness, dizziness, backache, and heavy menstrual bleeding\u0026rdquo;.\u003c/em\u003e \u003cb\u003e(IDI, Upper Bonda)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Didi, when I consumed the Mall-D (Pill) tablet after one childbirth. After a long gap, I have conceived\u0026rdquo;.\u003c/em\u003e \u003cb\u003e(FGDs, Lower Bonda)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Didi, when I used copper T, my health issues arose like, after delivery, there was a shortage of milk\u0026rdquo;.\u003c/em\u003e \u003cb\u003e(FGDs, Lower Bonda)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cb\u003eSubtheme (IV): Factors influencing contraceptive decisions.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eAs a whole, the story emphasizes the difficulties and complexities associated with family planning decisions, such as the influence of cultural expectations on reproductive decisions among the Bonda people. There are communication gaps in married relationships, and in the role played by mothers-in-law in influencing daughters-in-law's decision to use contraception. The situations discussed above highlight the need for spouses to communicate better and understand the importance of women's reproductive health. The study places a strong emphasis on physical violence against women and the safety of the child first. The study also highlights that the husband is drunk and harassing the woman mentally. These elements were found to be significant barriers preventing the use of contraceptive methods.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;When my husband came to know about copper T, that I was using without his consent. He used to come home getting drunk and beat me\u0026rdquo;. \u0026ldquo;My mother-in-law also scolded me every day-night after drinking alcohol\u0026hellip;because my mother-in-law was afraid, I would not be able to give birth child in the future\u0026rdquo;.\u003c/em\u003e \u003cb\u003e(FGDs, Upper Bonda 33 years)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;After giving birth to my second child, I had to take copper T, I took copper T on my own choice, and my spouse did not know about it. He always used to come at night after drinking, and due to this, I never discussed it with him. After 25 days of delivery, he was trying to get physical with me. When I refused to intimate him and tried to tell him, he got angry. He scolds me harshly pick up my 25-day child and threw him outside the home. The child\u0026rsquo;s leg broke, and he scolded me and warned me if you do not support me, I would marry another girl. The researcher asked her if she removed Cooper-T after the fight, and she said no I did not remove it I used it for two years. I told the doctor that again (Sir) I have been using Copper-T for 2 years, so now I want to remove it, they removed it, and now I want a girl child: then, I will go for female sterilization\u0026rdquo;.\u003c/em\u003e \u003cb\u003e(IDI, Lower Bonda, 28 years)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cb\u003eTheme 3- Cultural and Societal Expectations related to gender roles and family dynamics within the Bonda community.\u003c/b\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eSubtheme (I): Gender preference, Economic Influence, and Future Support Concerns\u003c/h2\u003e \u003cp\u003eThe following statements reflect sociocultural perspectives and concerns regarding gender roles, family dynamics, and expectations in the context of the Bonda community.\u003c/p\u003e \u003cp\u003eIn the Bonda community, the birth of girls is associated with increased bride prices. The cultural concept of '\u003cem\u003eJalla\u003c/em\u003e,' or the bride price is viewed as a source of income when a daughter marries and enhances household capabilities. This is in contrast with the idea that boys may leave their parents after marrying. Gender-based roles and responsibilities are distinctly defined, with the expectation that daughters will provide multifaceted support, economic support, and caregiving, while sons are proposed as potential sources of support in the later stages of life.\u003c/p\u003e \u003cp\u003eThey expressed concerns about having only one or two children. The fear is that a small number of children may not be sufficient to provide support in old age, take care of health, or ensure necessities such as food. The desire for a son is tied to the belief that only a male child can ensure the continuity of the family lineage and provide support in old age, as highlighted in the provided quotes.\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eIf I give birth to a girl\u0026rsquo;s child, then the girl will become older, she will take care of our health in old age, the boys will leave us after getting married, and the girls will not\u0026rdquo;.\u003c/em\u003e \u003cb\u003e(FGD, Upper Bonda)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eWhen my daughter (ankui da/Toki) gets married, we will get \u0026ldquo;Jalla\u0026rdquo; (Bride price) from the groom\u0026rsquo;s (umpar/munus ghar) house. The girl will do both the work financial support and old age support\u0026rdquo;.\u003c/em\u003e \u003cb\u003e(FGDs, Upper Bonda and Lower Bonda, 41 years)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eIf more girls are born, then we will get more income in terms of the Bride price; if a boy child is born, then we will get old age support (Dokra dokri wo kiang beyita)\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003e(IDI, Upper Bonda)\u003c/h2\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eMy husband wants a boy child, I have five girls children since we need one boy child because of our future generation, and if my daughter gets married, she will go to another house who will take responsibility for our wealth and our health; that\u0026rsquo;s why I am not adopting any contraceptive for the hope of boy child and for the tension of boy child, my husband got always drunk\u0026rdquo;.\u003c/em\u003e \u003cb\u003e(IDI, Lower and Upper Bonda)\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe Bonda people emphasized that as more children are born, they will receive additional help, financial help, and old age support.\u003c/p\u003e \u003cp\u003e\u0026ldquo;If we have one or two children, then they will not survive in the future; who will give support to our old age? Who will take care of our health, who will give us food\u0026rdquo;.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003e(FGDs, Upper Bonda, 35 years)\u003c/h2\u003e \u003cdiv id=\"Sec24\" class=\"Section4\"\u003e \u003ch2\u003eSubthemes (II): Challenges in Contraception among Bonda Husbands: Unraveling Societal Dynamics\u003c/h2\u003e \u003cp\u003eBonda husbands reject contraceptive methods due to male dominance in their society, where men's decisions are superior. Existence, including biological needs and sexual desires, is crucial. Both Bonda women and men fear losing partners, leading to observed sexual promiscuity. Historical practices, such as polygamy, play a crucial role in shaping attitudes toward contraceptive methods.\u003c/p\u003e \u003cp\u003eSeveral reasons contribute to the unwillingness of Bonda husbands to adopt contraceptive methods. A lack of awareness about contraceptive options is prevalent, as education and information dissemination may not be prioritized. Additionally, there may be concerns about reduced sexual enjoyment, economic implications, and negative health impacts associated with contraceptive use.\u003c/p\u003e \u003cp\u003eThe challenge of contraceptive methods among Bonda husbands is deeply rooted in the cultural and historical context of their society. Addressing these challenges would likely require a comprehensive approach, including education, awareness campaigns, and a shift in societal norms, to encourage more open discussions about family planning and reproductive health.\u003c/p\u003e \u003cp\u003eWork prioritization over health is influenced by low socioeconomic status, and individuals rely on production and a subsistence economy. Bonda men worry that contraception's side effects will hamper agricultural activities, resulting in decreased household productivity. Furthermore, the study identified side effects and a lack of husband/family support as factors that may contribute to the discontinuation of contraceptives. Some of the quotes are described in the following section.\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eHusbands do not allow their wives to do family planning because they do not know anything about family planning, because husbands do not go to attend meetings where health workers talk about health care, pregnancy, and family planning practices. Side effects can harm their socioeconomic activities\u0026rdquo;.\u003c/em\u003e \u003cb\u003e(Key informants)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eMy husband opposes family planning methods because he thinks that if a woman chooses family planning, he will be unable to enjoy sexual desires\u003c/em\u003e\u0026rdquo;. \u003cb\u003e(FGDs, Lower Bonda)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eMy husband refused to do this because it has many side effects on health due to this; we are not able to do household work\u003c/em\u003e\u0026rdquo;. \u003cb\u003e(FGDs, lower/upper Bonda)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Selangeng to one woman in FGD, the fear of losing their wives the male members believe that if women use Female Sterilization, they will stop having children and look young (selange, change) and healthy. If their women appear healthy and attractive, then the other male member will capture the women\u0026rdquo;.\u003c/em\u003e \u003cb\u003e(FGDs, Lower Bonda)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eIf I use the contraceptive method, then I will become ill, due to my illness, my husband will marry another woman. Because they will have reason to say you are unable to perform any household work because of health issues\u0026rdquo;.\u003c/em\u003e \u003cb\u003e(Upper Bonda, FGD)\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003e4-Perception of healthcare providers\u003c/h2\u003e \u003cp\u003e \u003cb\u003eSubtheme (I) - Resistance faced by health workers while providing counseling/services.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eAccording to ANM/Asha, there was a lack of awareness programs, educational communication, or initiatives to increase women\u0026rsquo;s knowledge of contraceptives. The Bonda believed that healthcare professionals often mislead us by providing only partial information. Because of illiteracy and lack of suitable promotions of contraceptives by healthcare professionals, many women lack awareness about contraceptives. If a healthcare provider comes to create awareness, then there is no road to reach each village, and there are no proper conditions for such quarters to stay there. That\u0026rsquo;s health workers would face many such things that\u0026rsquo;s why they stay in the city area and would not be able to do their job properly.\u003c/p\u003e \u003cp\u003eThe absence of government-sponsored information, awareness programs, educational communication, or initiatives dedicated to enhancing women's knowledge of contraceptives, as reported by auxiliary nurse midwives (ANMs), emphasizes a significant gap in reproductive health services for the Bonda community. The need for targeted educational efforts contributes to a critical information deficit, hampering informed decision-making regarding reproductive health within the Bonda population. Addressing these gaps through comprehensive and culturally sensitive reproductive health programs is crucial for empowering women with accurate information and adopting a better understanding of contraceptive options.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThere are some women who listen to teachers, Anganwadi, Asha and they come for pills but take them for one day, forget them the next day and drink alcohol or go somewhere for work, then forget them completely the next day. If they have taken medicine, they do not maintain the calendar properly; that is why even after taking medicine, some of them suffer.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section3\"\u003e \u003ch2\u003e(IDI from Doctor, Pharmacist, ANM/Health Care Professionals)\u003c/h2\u003e \u003cp\u003eBoth recipients of healthcare services and healthcare providers often lack awareness of government plans and policies. When Bonda women use pills, they may not follow to proper usage, neglect adequate rest, consume alcohol daily, or fail to maintain a nutritious diet, resulting in weakness and dizziness.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study undertook a qualitative investigation to gain a comprehensive understanding of the barriers hampering the adoption of modern family planning (FP) methods, as well as the barriers/challenges related to contraceptive usage, the management of unwanted pregnancies, and the spacing between children among the Bonda tribe of the hill pockets of the Eastern Ghats Mountain Range located in the Malkangiri district of Odisha, India. These findings reveal several reasons for the existence of barriers to and discontinuation of contraceptive usage.\u003c/p\u003e \u003cp\u003eThe current study highlights a notably low prevalence rate of contraceptive use among the Bonda community, especially concerning temporary methods employed by males, which are nearly nonexistent. While most individuals in the region are familiar with at least three types of family planning (FP) methods, there is a gap in preparedness for future use or guidance from others. Despite awareness of modern contraceptives, a limited percentage of women possess knowledge about family planning methods, as evidenced by previous studies (Swamy et al., 2017) (Mishra et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), (Ochako et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), (Palo et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), (Mushy et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), and (Sowmya et al., 2020), (Sekine et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). (Prusty, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2014\u003c/span\u003e) reported that even though tribal women were aware of FP methods in Jharkhand, only 17% utilized any modern contraception, in contrast to 39% of nontribal women. (Dansereau et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) found that even when women were aware of family planning methods, they often lacked comprehensive information about them, indicating a gap in understanding and access to detailed information on various contraceptive options. This deficiency in knowledge persists despite their awareness. This lack of awareness and knowledge underscores the importance of improving education and communication regarding available family planning services, particularly emphasizing the accessibility and cost-free nature of these services at public healthcare facilities. Enhancing awareness can contribute to informed decision-making and increased utilization of family planning services among married adolescent girls. (Jhariya et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2013\u003c/span\u003e) indicated that among the Baiga community in Madhya Pradesh, 46% of couples were identified as users of contraception, while 54% were classified as nonusers. This finding suggested a diverse range of family planning practices within the Baiga community in Madhya Pradesh, with slightly less than half of the couples actively utilizing contraception. (Mushy et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) studied Tanzania, and reported that all participants were aware of modern family planning (FP) methods. A majority of participants exhibited knowledge by listing various contraceptives and explaining their mechanisms. This indicates a generally high level of awareness and understanding among the participants, reflecting positively on the study.\u003c/p\u003e \u003cp\u003eMost participants in the studied area indicated that they had undergone an unconsented contraceptive procedure, which was an unusual practice in previous Indian studies. This practice is aimed at spacing childbirths and for the financial purpose of health workers. This unauthorized use of contraception has resulted in side effects that adversely affect the household economy, physical health, and mental well-being, placing unnecessary pressure on women to discontinue the method. The research also identified grassroots-level workers as the primary barriers to mistrust, access, or discontinuation of future contraception. The study findings indicate the occurrence of violent professional behavior in which the provider does not ask for consent or inadequate communication among the participants related to health procedures, and some of the studies have investigated related topics (Mwasha et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), (Nanvubya et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe primary reason Bonda women stopped using contraceptive methods was the occurrence of side effects. The study revealed that various side effects, including foul-smelling discharge, severe white discharge, fear of fertility issues, back pain, weakness, dizziness, and irregular menstruation, were major contributors to the discontinuation of contraceptive use among the Bonda tribe. Similarly, findings from other studies at the international level widely reported the side effects of contraceptives, viz., men expressed frustration with side effects, irregular and prolonged bleeding, dryness in the vaginal area, declines in sexual desire, concern about physical health, side effects and fear of long-term impacts. Irregular menstrual cycles, dizziness, headaches, stomachaches, weight gain, and weight loss are among the most commonly reported side effects associated with various contraceptive methods (Carter et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2012\u003c/span\u003e) (Kabagenyi et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2014\u003c/span\u003e), (Ajayi et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2016\u003c/span\u003e),(Swamy et al., 2017), (Dansereau et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) (Rios-Zertuche et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), (Ochako et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), (Silumbwe et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), (Mushy et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Similarly, at the national level, studies have been conducted (Hall et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2008\u003c/span\u003e), (Rustagi et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2010\u003c/span\u003e), (Bhattathiry \u0026amp; Ethirajan, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2014\u003c/span\u003e) (Mishra et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), (Manna et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), (Sowmya et al., 2020), (Sekine et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), (Jain et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eVarious myths about copper T, such as displacement into the abdomen causing cancer, fear of fertility issues, shortage of milk, irregular menstruation, and reduced earning capacity, further act as barriers. These misconceptions stem from unsuitable information received from friends, relatives, and husbands. In this context, similar findings on myths and misconceptions as barriers to contraceptive use are documented in such studies (Adongo et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2013\u003c/span\u003e) (Ochako et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2015\u003c/span\u003e), (Mishra et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), (Hameed \u0026amp; Avan, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), (Palo et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) studied PVTGs of Odisha in the Keonjhar district and revealed that women in the study area expressed strong barriers toward permanent sterilization due to a cultural belief that undergoing such a procedure would prohibit them from participating in worship practices associated with their religion or belief system. The present study states that myths and misconceptions create the primary barriers preventing Bonda women from using contraceptive methods, as adopting family planning methods hampers their ability to work in strenuous labor.\u003c/p\u003e \u003cp\u003eFurthermore, this study revealed that family pressure and a lack of spousal support play significant roles in preventing women from adopting contraceptive methods. Similar findings were observed in the study by (Rustagi et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2010\u003c/span\u003e), where many participants hesitated to use contraceptives without their partner's consent, and familial pressure to have more children emerged as a major obstacle to contraceptive avoidance.\u003c/p\u003e \u003cp\u003eInterestingly, the Bonda tribe shows a strong preference for having daughters after marriage, expressing a keen desire for pregnancy and a preference for female children. The study revealed that having more female children is associated with an increase in the bride price received by the parental household, which is associated with a similar observation in the Keonjhar district of Odisha (Palo et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Simultaneously, the Bonda equally valued male children as economic assets. This highlights the inclination of the Bonda community toward larger families, as they believe it leads to more children, increased income, and additional assistance in household activities, particularly in agriculture and slash cultivation. Contrary to these findings, (Rustagi et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2010\u003c/span\u003e) observed inconsistent findings in a minority community in Delhi, where the majority of women agreed that a large family size is undesirable due to its association with a lower quality of life, increased expenditures, and a decline in women's health. Like a qualitative study conducted by (Kabagenyi et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2014\u003c/span\u003e) in two rural districts in Uganda, a preference for large families was noted, as a symbol of wealth and financial security. Additionally, in Rajasthan, there is a cultural need for a large number of sons according to (Singh \u0026amp; Srinivasan, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2000\u003c/span\u003e), and in Gujarat (Kumar \u0026amp; Joshi, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2008\u003c/span\u003e) and West Bengal (Manna et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), cultural perspectives influence family size.\u003c/p\u003e \u003cp\u003eResearch conducted in Uganda highlighted a lack of male involvement in family planning (Kabagenyi et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). In southern Ghana (Adongo et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2013\u003c/span\u003e), as well as in the study by (Davis et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2016\u003c/span\u003e), there was unanimous agreement on the benefits of involving men in family planning and maternal and child health (MCH), as it was found to increase the utilization of family planning services.\u003c/p\u003e \u003cp\u003eAccording to the study, shyness in discussing contraceptive use with spouses and healthcare providers serves as another barrier to the discontinuation of contraceptive methods. Participants lacked the awareness and autonomy to communicate effectively with their partners and healthcare professionals. Unfamiliarity with healthcare providers and contraceptive methods left participants unable to make decisions about using contraceptives, as they relied on others to make these choices. This finding is consistent with a study conducted in Nepal's Bara district (Sekine et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), where adolescent girls exhibited shyness in discussing contraception and childbearing.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe primary barriers to the discontinuation of modern contraceptive methods among the Bonda tribe in Malkangiri district, Odisha, include limited knowledge and awareness about modern contraceptive methods hampering their consistent use, deep-rooted cultural beliefs and traditional perceptions surrounding family planning contribute to resistance or discontinuation, procedures carried out without the individual's consent may lead to mistrust and discontinuation of contraceptive methods, side effects; myths and misconceptions, family/husband mindsets, gender preferences/economic influence, and lack of government-sponsored initiatives. These are the barriers collectively play a significant role in influencing the discontinuation of modern contraceptive methods, emphasizing the need for targeted interventions and awareness campaigns to address these challenges.\u003c/p\u003e \u003cp\u003e \u003cb\u003eResearch implications.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThese findings suggest the need for targeted policy interventions aimed at educating both men and women about FP methods. Ensuring easy access to health care services for women experiencing side effects. The study also highlights ethical and legal concerns related to medical procedures and informed consent. Addressing limited housing options for healthcare professionals is crucial for ensuring accessible and timely medical care. This will involve collaboration between healthcare institutions, local authorities, and relevant participants to improve living conditions for healthcare providers. Addressing such misconceptions is necessary for promoting informed and empowered reproductive health choices among Bonda women. Education and awareness programs that dismiss myths and provide accurate information about family planning methods can play a crucial role in helping individuals adopt a supportive environment for reproductive health decisions within the community.\u003c/p\u003e \u003cp\u003eThis research underscores the necessity of targeted policy measures to educate both genders on family planning (FP) methods. These findings emphasize the importance of facilitating women's access to healthcare services to manage side effects effectively. Additionally, the study identified ethical and legal issues surrounding medical procedures and provided informed consent. The crucial need to improve housing options for healthcare professionals to ensure timely medical care is emphasized, requiring collaboration among healthcare institutions, local authorities, and relevant stakeholders. Overcoming misconceptions is vital for informed reproductive health choices among Bonda women. Education programs dispelling myths and offering accurate information on FP methods are key to fostering a supportive community environment for reproductive decisions.\u003c/p\u003e \u003cdiv id=\"Sec29\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eWomen who met the inclusion criteria were selected using purposive sampling. The study's limitations include the use of a small sample size and the lack of use of software for analyzing qualitative data.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003ch2\u003eConflict of interest statement\u003c/h2\u003e \u003cp\u003eThe Author(s) declares that there are no conflicts of interest.\u003c/p\u003e \u003cp\u003e\u003cstrong\u003eFunding Details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the National Fellowship and Scholarship for Higher Education of ST Students (NFST), New Delhi, India, vide Ref. No: 201819-NFST-ODI-02326.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003e1-Ranjita Nayak- She conceptualized and selected the paper's title and also acquired ethical approval, ensuring that the research followed ethical guidelines. Ranjita Nayak undertook significant fieldwork, obtaining primary data for the study. She thoroughly analyzed the acquired data with her knowledge and contributed significantly to the paper's writing, providing unique insights and interpretations.2-Sonia Kaushal contributed significantly to the paper's methodology portion. Her suggestions for organizing and improving the research techniques improved the study's overall quality and reliability. In addition, Sonia Kaushal had responsibility for editing the entire document, guaranteeing clarity, consistency, and conformity to academic guidelines. Her careful editing and framing substantially enhanced the paper's appearance and readability.3- A.N. Sharma- A.N. Sharma was involved in the early stages of the research endeavor. He identified the precise area of study and sampling process.\u003c/p\u003e\u003ch2\u003eAcknowledgments\u003c/h2\u003e \u003cp\u003e We extend sincere gratitude to our study participants for their valuable time and cooperation in responding to our inquiries. Special thanks are extended to the administrative and ethical approval of the Institutional Ethical Committee, IEC Approval vides letter number: DHSGV/IEC/2022/05 of Dr. Harisingh Gour Vishwavidyalaya, Sagar, M.P. (India). We express our gratitude to all the governmental bodies of Malkangiri district, Odisha, India, for granting permission to conduct the research. Their collaboration significantly contributed to the success of our research endeavor. Sincere thanks also go to the National Fellowship and Scholarship for Higher Education of ST Students (NFST), New Delhi, India, for financial support in terms of fellowship vide Ref. No: 201819-NFST-ODI-02326.\u003c/p\u003e\u003ch2\u003eAvailability of Data\u003c/h2\u003e \u003cp\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request. The study data pertains to one of the marginalised tribal groups in India and contains sensitive information. Therefore, to protect the integrity and privacy of the respondents, and as per the ethical guidelines, the data is restricted and cannot be made public.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAB Ota, S. C. M. (2007). Scheduled Castes \u0026amp; Scheduled Tribes Research and Training Institute (SCSTRTI) Bhubaneswar - 751003. In \u003cem\u003eBonda\u003c/em\u003e. http://www.brti.co.zw/background-objectives/\u003c/li\u003e\n\u003cli\u003eAbdi, B., Okal, J., Serour, G., \u0026amp; Temmerman, M. (2020). \u003cem\u003e\u0026ldquo; Children are a blessing from God \u0026rdquo; \u0026ndash; a qualitative study exploring the socio-cultural factors influencing contraceptive use in two Muslim communities in Kenya\u003c/em\u003e. 1\u0026ndash;11.\u003c/li\u003e\n\u003cli\u003eAbout District Malkangiri, Government of Odisha, I. (2023). \u003cem\u003eNIC-Malkangiri\u003c/em\u003e.\u003c/li\u003e\n\u003cli\u003eAdongo, P. B., Tapsoba, P., Phillips, J. 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A qualitative study of contraceptive understanding among young adults. \u003cem\u003eContraception\u003c/em\u003e, \u003cem\u003e86\u003c/em\u003e(5), 543\u0026ndash;550. https://doi.org/10.1016/j.contraception.2012.02.017\u003c/li\u003e\n\u003cli\u003eDansereau, E., Schaefer, A., Hern\u0026aacute;ndez, B., Nelson, J., Palmisano, E., R\u0026iacute;os-Zertuche, D., Woldeab, A., Z\u0026uacute;\u0026ntilde;iga, M. P., Iriarte, E. M., Mokdad, A. H., \u0026amp; El Bcheraoui, C. (2017). Perceptions of and barriers to family planning services in the poorest regions of Chiapas, Mexico: A qualitative study of men, women, and adolescents. \u003cem\u003eReproductive Health\u003c/em\u003e, \u003cem\u003e14\u003c/em\u003e(1), 1\u0026ndash;10. https://doi.org/10.1186/s12978-017-0392-4\u003c/li\u003e\n\u003cli\u003eDanton, E. H. (2014). Benefit of Family planning. In M. Deborah R. McFarlane, DrPH (Ed.), \u003cem\u003eGlobal population and reproductive health\u003c/em\u003e (Vol. 199).\u003c/li\u003e\n\u003cli\u003eDarney, B. G., Sosa-Rubi, S. G., Servan-Mori, E., Rodriguez, M. I., Walker, D., \u0026amp; Lozano, R. (2016). The relationship of age and place of delivery with postpartum contraception before discharge in Mexico: A retrospective cohort study. \u003cem\u003eContraception\u003c/em\u003e, \u003cem\u003e93\u003c/em\u003e(6), 478\u0026ndash;484. https://doi.org/10.1016/j.contraception.2016.01.015\u003c/li\u003e\n\u003cli\u003eDavis, J., Vyankandondera, J., Luchters, S., Simon, D., \u0026amp; Holmes, W. (2016). 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(2018). \u003cem\u003eHHS Public Access\u003c/em\u003e. \u003cem\u003e5\u003c/em\u003e(6). https://doi.org/10.5958/2249-7315.2015.00132.X.Barriers\u003c/li\u003e\n\u003cli\u003eHall, M. A. K., Stephenson, R. B., \u0026amp; Juvekar, S. (2008). Social and logistical barriers to the use of reversible contraception among women in a rural Indian Village. \u003cem\u003eJournal of Health, Population and Nutrition\u003c/em\u003e, \u003cem\u003e26\u003c/em\u003e(2), 241\u0026ndash;250.\u003c/li\u003e\n\u003cli\u003eHameed, W., \u0026amp; Avan, B. I. (2018). Women\u0026rsquo;s experiences of mistreatment during childbirth: A comparative view of home- and facility-based births in Pakistan. \u003cem\u003ePLoS ONE\u003c/em\u003e, \u003cem\u003e13\u003c/em\u003e(3), 1\u0026ndash;17. https://doi.org/10.1371/journal.pone.0194601\u003c/li\u003e\n\u003cli\u003eHubacher, D., Mavranezouli, I., \u0026amp; McGinn, E. (2008). 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(2008). \u003cem\u003eDevelopment in Practice Family-planning methods among the tribal population in south Gujarat : a case study of access and usage Family-planning methods among the tribal population in south Gujarat : a case study of access and usage\u003c/em\u003e. \u003cem\u003e4524\u003c/em\u003e. https://doi.org/10.1080/09614520801899168\u003c/li\u003e\n\u003cli\u003eManna, N., Bhattacharjee, A., Kundu, A., \u0026amp; Lahiri, A. (2019). Non-acceptance of Injectable Contraceptives from Antara Clinic: A Qualitative Study in West Bengal, India. \u003cem\u003eIOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN\u003c/em\u003e, \u003cem\u003e18\u003c/em\u003e(3), 48\u0026ndash;51. https://doi.org/10.9790/0853-1803114851\u003c/li\u003e\n\u003cli\u003eMishra, N., Panda, M., Pyne, S., Srinivas, N., Pati, S., \u0026amp; Pati, S. (2017). 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Barriers to the uptake of modern family planning methods among female youth of Temeke District in Dar es Salaam, Tanzania: A qualitative study. \u003cem\u003eSexual and Reproductive Healthcare\u003c/em\u003e, \u003cem\u003e24\u003c/em\u003e(June 2019), 100499. https://doi.org/10.1016/j.srhc.2020.100499\u003c/li\u003e\n\u003cli\u003eMwasha, L. K., Kisaka, L. M., \u0026amp; Pallangyo, E. S. (2023). Disrespect and abuse in maternity care in a low-resource setting in Tanzania: Provider\u0026rsquo;s perspectives of practice. \u003cem\u003ePLoS ONE\u003c/em\u003e, \u003cem\u003e18\u003c/em\u003e(3 March), 1\u0026ndash;12. https://doi.org/10.1371/journal.pone.0281349\u003c/li\u003e\n\u003cli\u003eNanvubya, A., Wanyenze, R. K., Kamacooko, O., Nakaweesa, T., Mpendo, J., Kawoozo, B., Matovu, F., Nabukalu, S., Omoding, G., Kaweesi, J., Ndugga, J., Bagaya, B., Chinyenze, K., Price, M., \u0026amp; Van Geertruyden, J. P. (2020). Barriers and Facilitators of Family Planning Use in Fishing Communities of Lake Victoria in Uganda. \u003cem\u003eJournal of Primary Care and Community Health\u003c/em\u003e, \u003cem\u003e11\u003c/em\u003e. https://doi.org/10.1177/2150132720943775\u003c/li\u003e\n\u003cli\u003eNazar-Beutelspacher, A., Molina-Rosales, D., Salvatierra-Izaba, B., Zapata-Martelo, E., \u0026amp; Halperin, D. (1999). Education and Nonuse of Contraceptives among Poor Women in Chiapas, Mexico. \u003cem\u003eInternational Family Planning Perspectives\u003c/em\u003e, \u003cem\u003e25\u003c/em\u003e(3), 132\u0026ndash;138. https://doi.org/10.2307/2991962\u003c/li\u003e\n\u003cli\u003eOchako, R., Mbondo, M., Aloo, S., Kaimenyi, S., Thompson, R., Temmerman, M., \u0026amp; Kays, M. (2015). Barriers to modern contraceptive methods uptake among young women in Kenya: A qualitative study Global Health. \u003cem\u003eBMC Public Health\u003c/em\u003e, \u003cem\u003e15\u003c/em\u003e(1), 1\u0026ndash;9. https://doi.org/10.1186/s12889-015-1483-1\u003c/li\u003e\n\u003cli\u003eOchako, R., Okal, J., Kimetu, S., Askew, I., \u0026amp; Temmerman, M. (2018). \u003cem\u003eFemale sex workers experiences of using contraceptive methods : a qualitative study in Kenya\u003c/em\u003e. 1\u0026ndash;10.\u003c/li\u003e\n\u003cli\u003ePalo, S. K., Samal, M., Behera, J., \u0026amp; Pati, S. (2020). Tribal eligible couple and care providers\u0026rsquo; perspective on family planning: A qualitative study in Keonjhar district, Odisha, India. \u003cem\u003eClinical Epidemiology and Global Health\u003c/em\u003e, \u003cem\u003e8\u003c/em\u003e(1), 60\u0026ndash;65. https://doi.org/10.1016/j.cegh.2019.04.008\u003c/li\u003e\n\u003cli\u003ePanda, S. N., Barik, M., Acharya, A. S., \u0026amp; Kanungo, S. 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Contraceptive knowledge and use among women living in the poorest areas of five Mesoamerican countries. \u003cem\u003eContraception\u003c/em\u003e, \u003cem\u003e95\u003c/em\u003e(6), 549\u0026ndash;557. https://doi.org/10.1016/j.contraception.2017.01.005\u003c/li\u003e\n\u003cli\u003eRustagi, N., Taneja, D. K., Kaur, R., \u0026amp; Ingle, G. K. (2010). Factors affecting contraception among women in a minority community in Delhi: A qualitative study. \u003cem\u003eHealth and Population: Perspectives and Issues\u003c/em\u003e, \u003cem\u003e33\u003c/em\u003e(1), 10\u0026ndash;15.\u003c/li\u003e\n\u003cli\u003eSekine, K., Khadka, N., Carandang, R. R., Ing, K., Ong, C., Tamang, A., \u0026amp; Jimba, M. (2021). \u003cem\u003eMultilevel factors influencing contraceptive use and childbearing among adolescent girls in Bara district of Nepal : a qualitative study using the socioecological model\u003c/em\u003e. 1\u0026ndash;10. https://doi.org/10.1136/bmjopen-2020-046156\u003c/li\u003e\n\u003cli\u003eShewale, S., \u0026amp; Sahay, S. (2022). Barriers and facilitators for access and utilization of reproductive and sexual health services among Female Sex Workers in urban and rural Maharashtra, India. \u003cem\u003eFrontiers in Public Health\u003c/em\u003e, \u003cem\u003e10\u003c/em\u003e. https://doi.org/10.3389/fpubh.2022.1030914\u003c/li\u003e\n\u003cli\u003eSilumbwe, A., Nkole, T., Munakampe, M. N., Milford, C., Cordero, J. P., Kriel, Y., Zulu, J. M., \u0026amp; Steyn, P. S. (2018). 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Contraceptive utilization and barriers in Karnataka, Southern India: A survey on women residing in slums. \u003cem\u003eClinical Epidemiology and Global Health\u003c/em\u003e, \u003cem\u003e8\u003c/em\u003e(4), 1077\u0026ndash;1081. https://doi.org/10.1016/j.cegh.2020.03.023\u003c/li\u003e\n\u003cli\u003eStarbird, E., Norton, M., \u0026amp; Marcus, R. (2016). Investing in family planning: Key to achieving the sustainable development goals. \u003cem\u003eGlobal Health Science and Practice\u003c/em\u003e, \u003cem\u003e4\u003c/em\u003e(2), 191\u0026ndash;210. https://doi.org/10.9745/GHSP-D-15-00374\u003c/li\u003e\n\u003cli\u003eSwamy, H. T., M., B., B. S., N. K., \u0026amp; N. S., S. (2017). A qualitative study on determinants of choice of contraceptives in a rural. \u003cem\u003eInternational Journal Of Community Medicine And Public Health\u003c/em\u003e, \u003cem\u003e4\u003c/em\u003e(6), 1943. https://doi.org/10.18203/2394-6040.ijcmph20172154\u003c/li\u003e\n\u003cli\u003eUNDESA. (2022). World Family Planning. In the \u003cem\u003eUnited Nations\u003c/em\u003e. https://www.un.org/en/development/desa/population/publications/pdf/family/WFP2017_Highlights.pdf\u003c/li\u003e\n\u003cli\u003eVerrier Elwin. (1950). Bondo-highlander by Varrier Elwin. In \u003cem\u003eBOOK\u003c/em\u003e.\u003c/li\u003e\n\u003cli\u003eWHO. (2007). Standards for Maternal and Neonatal Care. \u003cem\u003eWHO Library\u003c/em\u003e, 1\u0026ndash;72.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Challenges, Contraceptives, Awareness, Family Planning, Copper-T, Gender preference, physical violence, Barriers, Bonda women, Odisha","lastPublishedDoi":"10.21203/rs.3.rs-3940688/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3940688/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eFamily planning practices play a crucial role in avoiding unintended pregnancies and the preventable mortality associated with childbirth that occurs either \u0026lsquo;too soon\u0026rsquo; or \u0026lsquo;too frequently.\u0026rsquo; These practices significantly influence the health outcomes of mothers, newborns, and children.\u003c/p\u003e\u003ch2\u003eAim\u003c/h2\u003e \u003cp\u003eThis research aims to conduct a qualitative investigation to gain a comprehensive understanding of the existing barriers related to modern family planning methods, along with contraceptive use, the management of unwanted pregnancies, and spacing between two children. Also, the study examines the influence of healthcare providers, mothers/mothers-in-law, and husbands on family planning practices within the Bonda tribe in the Malkangiri district of Odisha, India.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eUtilizing a qualitative method, the investigation incorporated 8 Focus Group Discussions, 7 In-depth Interviews, and insights from 16 key informants.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThematic analysis was employed to reveal instances of unconsented contraceptive procedures, reproductive health complications, and challenges in contraception methods: unraveling societal dynamics and cultural barriers impacting family planning practices among Bonda women.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe study highlights the crucial need for enhanced maternity care and underscores the importance of culturally sensitive services. Furthermore, it promotes provider training to ensure satisfaction, equity, and professionalism in care childbirth for tribal women. The findings strongly indicate that addressing these issues can potentially enhance family planning outcomes among the Bonda tribe.\u003c/p\u003e","manuscriptTitle":"Challenges in Modern Contraception Access among Married Bonda Women: Insights from a Qualitative Study on Family Planning Barriers and Healthcare Dynamics","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-02-22 16:35:49","doi":"10.21203/rs.3.rs-3940688/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0f149c95-53dd-4efd-8764-27f009f47531","owner":[],"postedDate":"February 22nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-09-30T09:24:08+00:00","versionOfRecord":[],"versionCreatedAt":"2024-02-22 16:35:49","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3940688","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3940688","identity":"rs-3940688","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}