Analysis of the reports of contraceptive service providers in Mexico: between reproductive autonomy and contraceptive coercion

This study aimed to identify the narratives on reproductive autonomy and contraceptive coercion of family planning and contraceptive service providers, of administrative staff, and of the creators/operators of public policies in reproductive health based on the theoretical framework of quality of contraceptive counseling. This is a cross-sectional, exploratory and qualitative study. A total of 25 semi-structured interviews were conducted with 15 public health institutions located in rural, urban, and Indigenous communities in Mexico City and San Luis Potosí, México. Non-probabilistic convenience sampling was employed to ensure participants diversity. A deductive and inductive content analysis was conducted. The analysis enabled the identification of a set of narratives on reproductive autonomy, contraceptive coercion, and paternalism. Narratives on reproductive autonomy were observed more frequently in Mexico City, among women, with medical degrees, in health facilities, and in urban areas. Narratives with some degree of coercion or paternalism were cited most frequently in San Luis Potosí, by women, with degrees in Medicine and Nursing, in health facilities, and in rural areas. Paternalistic and coercive narratives represent a problem that impairs the quality of contraceptive information and services. To mitigate this problem and promote reproductive autonomy, health entities could adapt the quality of contraceptive counseling framework and incorporate the Quality of Contraceptive Counselling (QCC) Scale into Mexico's public healthcare system.