**Background:** Rapid urbanization in India has led to a growing population in informal settlements, where women face high unmet need for family planning. Despite national progress, Maharashtra state showed minimal improvement in contraceptive prevalence rate (CPR) from 62.6% to 63.8% between NFHS-4 and NFHS-5. This study aimed to understand perspectives on family planning and identify factors influencing modern contraceptive use among married women in Mumbai's informal settlements.
**Methods:** A mixed-methods design was employed in Malvani, a densely populated slum pocket in Mumbai's P-North ward. The quantitative component used endline survey data from a project by the NGO SNEHA, collected between January and March 2020. A stratified random sample of 1407 married women aged 15-49 years was drawn from 14,000 households across 73 clusters. The survey collected demographic, socioeconomic, and reproductive health data. Contraceptive Prevalence Rate (CPR) was calculated as the percentage of women using or whose partners were using any modern method. Logistic regression was used to identify factors associated with modern contraceptive use, adjusting for age, education, employment, religion, number of children, duration of residence, husband's education, uptake of family planning services, household size, and wealth index. Qualitative data were collected between August and December 2017 through face-to-face in-depth interviews with 22 women (13 users, 9 non-users of modern contraceptives), purposively selected from project records. Interviews explored perceptions of family planning, beliefs about methods, and barriers/enablers to use. Data were analyzed thematically.
**Key Results:** The quantitative survey found that 1070 out of 1407 women (76%) were using modern contraceptives. Among users, the highest proportions were women aged >30 years (39.6%), with 6-10 years of schooling (62.0%), living in Mumbai >10 years (63.8%), with ≤5 household members (61.2%), and who had used services from both NGOs and the public health system (52.8%). Logistic regression showed significantly higher odds of modern contraceptive use among women aged 26-30 years (AOR 1.58, 95% CI 1.08-2.32), those with 6-10 years of schooling (AOR 1.51, 95% CI 1.01-2.26) or >10 years (AOR 1.66, 95% CI 0.99-2.76), women with ≥3 children (AOR 2.75, 95% CI 1.91-3.94), those who availed NGO services only (AOR 1.80, 95% CI 1.27-2.57) or both NGO and public health services (AOR 14.8, 95% CI 9.39-23.35), and women in the least poor wealth quartile (AOR 1.74, 95% CI 1.10-2.75). Qualitative findings revealed that while all women were aware of modern contraceptives, use was primarily for limiting family size after achieving desired number of children, not for spacing. Many women experienced unplanned pregnancies and some resorted to unsafe abortions. Key barriers included fear of side effects (based on personal experience or hearsay), lack of spousal awareness and communication, social norms of early childbearing and completing family, religious beliefs (especially among Muslim women who viewed sterilization as a sin), and the taboo nature of discussing family planning. Enablers included support from family role models, counseling by frontline workers, and spousal awareness.
**Clinical Implications:** The study underscores that mere availability of contraceptives does not ensure voluntary uptake. To achieve rights-based family planning, programs must address misconceptions about side effects through counseling and follow-up, involve husbands in awareness sessions, and strengthen adolescent sexual and reproductive health education. Increasing women's age at marriage and promoting formal education are critical. Frontline workers should be equipped with IEC tools and counseling skills to provide method choice and manage side effects. Engaging community and religious leaders can help normalize family planning discussions. These strategies are essential to reduce unmet need and prevent unsafe abortions in vulnerable urban populations.