Women in rural India who live with their mothers-in-law have limited access to family planning because they lack relationships outside of the home, according to a recent study. 

The study, entitled “Curse of the Mummy-ji,” was the first of its kind to explore how a woman’s mother-in-law impacts her reproductive choices. 

A research team comprised of scholars from Northeastern University, Boston University, Boston College, and the Delhi School of Economics studied 671 young women, ages 18 to 30, in 28 villages in India’s Jaunpur district in the northern state of Uttar Pradesh. Most of these women, 67%, lived with their mothers-in-law and nearly 36% of them only spoke to her husband or mothers-in-law. The study suggests that their household situations limited the amount of critical information they could have received from health practitioners or friends.

“The dynamics of who is making the decisions about fertility and family planning are important for the welfare of the entire household,” Catalina Herrera-Almanza, an assistant professor of economics and international affairs at Northeastern, said in a news release. 

Can barriers to family planning be overcome? @NUCSSH's @cherreralmanza and her team of researchers are conducting a field study in rural Jaunpur, India to find out https://t.co/rEktjAJM9h

— NortheasternEcon (@NUEcon) October 23, 2019

Researchers found that mother-in-laws restricted women’s social networks by forbidding them from visiting places alone in an attempt to control their fertility and family planning behavior. For instance, only 14% of the women were allowed to go to a health facility alone. 

A woman who lived with her mother-in-law had 18% fewer "close peers" to talk to about health, fertility, and family planning than a woman who didn’t. On average, the women said they only had one or two peers in their districts — and even fewer friends. 

If the woman’s husband was a migrant worker, the mother-in-law exercised even more control over her mobility, interactions, independence, and decision making. Some women expressed that their mother-in-laws wanted them to have more sons than they did.

Read More: 5 Ways Family Planning Is Crucial to Gender Equality

Almost 50% of the women studied assumed that their mothers-in-law disapproved of birth control. 

"Women who have fewer close peers outside the home are less likely to visit health care facilities to receive reproductive health, fertility or family planning services, and are less likely to use a modern method of contraception," according to the study. 

The researchers said that when women have more mobility and access to information, it boosts self-confidence, builds peer companionship, and increases goals. Peers can inform health, fertility, and birth control-related decisions. 

While living with mothers-in-law can be beneficial during pregnancy, researchers believe the dynamic harms women’s freedom overall.

Read More: The World's Poorest Countries Are Using More Contraception — And It Could Cut Poverty

The number of women who live with their mothers-in-law varies by country. In the US, for example, only 18% of people live with their mothers-in-law, according to data collected by the Pew Research Center in 2012, but in Iraq, as many as 53% of women live with their extended families, a study by the University of Austria released in 2017 found.

"According to 2017 estimates, 214 million women of reproductive age in developing regions who want to avoid pregnancy are not using a modern contraceptive method," Tarik Jašarević, World Health Organization spokesperson, told Global Citizen. "Unmet need for contraception remains high in many settings, and is highest among the most vulnerable in society: adolescents, the poor, those living in rural areas and urban slums, people living with HIV, and displaced people."

Considering family dynamics could play an important role in addressing unplanned pregnancies and maternal health. Unplanned pregnancies are down in India, but the low fertility rate might not remain steady without more intervention, and varies from state to state. Child marriage, which limits young girls’ ability to make family reproductive health decisions, is still prevalent in the country, with approximately 1 in 4 young women married or in a union, according to UNICEF.

Read More: How UNFPA Supplies Is Working to Improve Women’s and Girls’ Reproductive Health

The researchers behind the study said policies to increase access to family planning and reproductive health must look at how mothers-in-law affect women’s decisions to see lasting change.

"Promotion of family planning — and ensuring access to preferred contraceptive methods for women, girls, and couples — is essential to securing the well-being and autonomy of women, while supporting the health and development of communities," Jašarević said.