Qualitative Examination of the Role and Influence of Mothers-in-Law on Young Married Couples' Family Planning in Rural Maharashtra, India

"These findings highlight the need for engagement of MILs for FP promotion in rural India and the potential utility of social norms interventions."

Unmet need for family planning (FP) continues to be high in India, especially among young and newly married women. Evidence suggests that many Indian women face high fertility pressure from extended family, especially mothers-in-law (MILs), due to prevalent social norms and expectations related to early birth as an indicator of a healthy marriage and son preference due to beliefs that sons can provide longer-term security for families. Data on perspectives of MILs on FP use in the household are important to guide their inclusion in intervention efforts. Designed to provide that data, this study was conducted in Junnar taluka (geographic subdistrict) in the Pune district of Maharashtra, India, as part of a larger FP intervention trial, the Counseling Husbands and wives to Achieve Reproductive Health and Marital equity (CHARM2) study. (See Related Summaries, below.)

From August 2019 to February 2020, trained female research staff carried out 10 focus group discussions (FGDs) with MILs of young married women (aged 18-29 years) participating in the CHARM2 study. FGDs included questions on their roles, attitudes, and decision making around fertility and FP.

MILs perceived their role as a parental figure and elder guide for the daughter-in-law (DIL), a parent and protector of their son, and a caregiver for their grandchildren. MILs reported having social norms of early fertility and son preference. They understood that family size norms are lower among DILs and that spacing can be beneficial but were not supportive of short-term contraceptives, especially before the first child. They preferred female sterilisation, opposed abortion, had apprehensions around side effects from contraceptive use, and had misconceptions about the intrauterine device, with particular concerns around its coercive insertion. MILs mostly believed that decision making should be done jointly by a husband and wife, but that as elders, they should be consulted and involved in the decision-making process.

MILs acknowledged resistance to traditional norms, recognising that DILs often have more education and potential employment opportunities compared to women of their generation and thus need to alter norms to accommodate these generational shifts. However, even among MILs supporting DILs' continued education or employment, domestic labour responsibilities were still expected of the women but not their husbands.

MILs reported they would value being involved in and participating in FP programmes primarily for 2 reasons: to be part of couples' decision making and to have an opportunity to learn. One way to integrate this study's learnings into FP programming is to address MILs' attitudes and involvement in reproductive decision making while including a focus on gender equity and women's agency so as not to reinforce MILs' control as decision makers. However, more research and formative work is needed to understand how to incorporate recognition of MILs' norms and attitudes into interventions in ways that do not detract from the DILs'/couples' FP agency and goals.

In conclusion, this "study shows that MILs of young couples have traditional attitudes about motherhood, about their entitlement to be involved in their sons' and DILs' decision making, and about their DIL's role in the family, all of which can compromise the centrality of DILs' reproductive autonomy. Further, many also report a preference for childbearing early in marriage and large family size, nonuse of contraceptives outside of female sterilization, and son preference...Future interventions may need to include components addressing MILs' attitudes and involvement in FP decision making, not only because of their potential influence on the couple in perpetuating detrimental gender norms but also because they can compromise DILs' reproductive autonomy."