Understanding the Low Uptake of Long-Acting Reversible and Permanent Contraceptive Methods in Bangladesh: A Qualitative Study

Background: Long-acting reversible and permanent contraception methods (LARC/PM) are safe and highly efficacious; however, current uptake remains persistently low in Bangladesh. This study sought to explore factors constraining LARC/PM uptake in Bangladesh. Methods: We adopted a cross-sectional qualitative research approach. Thirty-seven semi-structure, face-to-face in-depth interviews were conducted with married men and women, family planning service providers, and religious leader residing in the rural communities of the lowest performing district, Cumilla, Chattogram, Bangladesh. We analyzed the qualitative data utilizing the thematic analysis approach. Results : The findings underscore pervasive knowledge gaps and widespread misperceptions concerning LARC/PM, involving fears of infection, infertility, cancer, and sexual dysfunction, which are often fueled by anecdotal narratives. Interpersonal dynamics included spousal resistance and patriarchal gender norms limiting women’s reproductive autonomy, with female relatives shaping decisions. Resistance is further exacerbated by orthodox religious narratives and myths at the community level, framing LARC/PM. Institutional and policy level barriers to accessing LARC/PM services include irregular visits of family planning workers, limited counselling, providers’ biasness and divergent attitudes, shortages of manpower, low quality services. This study also demonstrates how social stigma, particularly in relation to sterilization renders social exclusion and psychological distress. Conclusion : Culturally sensitive interventions, involving men and religious authorities, are imperative to address knowledge gaps, dispel myths, and reduce stigma to foster a more supportive environment for LARC/PMuptake.