The coronavirus disease 2019 (COVID-19) pandemic has profoundly disrupted healthcare systems worldwide, compelling governments to reallocate resources toward infection control, vaccination programs, and emergency response measures (Arsenault et al., 2022; Bali et al., 2022; Smallwood et al., 2022). While these efforts were necessary, they inadvertently affected the delivery and continuity of essential health services, including family planning (FP). Evidence indicates that the pandemic led to significant reductions in FP utilization, particularly in low-resource and rural settings where healthcare access is already constrained (Banke-Thomas & Yaya, 2021; Karp et al., 2024; Mickler et al., 2021). These disruptions have been associated with increased unmet need for contraception, unintended pregnancies, and adverse maternal and reproductive health outcomes (Geleto et al., 2023; Rezaei et al., 2023).

In the Philippine context, the impact of COVID-19 on reproductive health services has been substantial. Estimates suggest a decline in contraceptive prevalence rates during community quarantine periods, with projections indicating millions of women experiencing disrupted access to FP services and a corresponding rise in unintended pregnancies (Marquez et al., 2020). Although family planning has been recognized as an essential health service during the pandemic (Marzouk et al., 2023; Mendoza & Ombao, 2022), disparities persist, particularly in geographically isolated and disadvantaged areas where access to healthcare facilities and supplies remains limited (Hayudini & Pangandaman, 2024; Karp et al., 2024).

Rural populations are disproportionately affected by structural barriers, such as limited transportation, shortages of healthcare providers, and socioeconomic constraints, which were further exacerbated by pandemic-related restrictions (Coombs et al., 2022; Duminy et al., 2021; Sigdel et al., 2023; Sileo et al., 2023). In such contexts, the continuity of FP services becomes critical, as effective contraceptive use has been shown to improve maternal and child health outcomes, regulate fertility, and enhance overall family well-being (Feriani et al., 2024). More importantly, access to and compliance with FP practices are closely linked to women’s quality of life (QoL), encompassing physical, psychological, social, and economic dimensions (Hazel et al., 2024; Miskeen et al., 2025; Skevington et al., 2024).

Despite these established relationships, a critical gap remains in the literature regarding the role of behavioral compliance with family planning—particularly in terms of attitudes and practices—in shaping women’s quality of life. Existing studies have predominantly focused on service utilization, access barriers, and contraceptive prevalence, with limited attention to how sustained compliance behaviors influence broader well-being outcomes. Furthermore, there is a scarcity of empirical evidence examining these relationships within culturally distinct and underserved populations, particularly in the context of public health crises such as the COVID-19 pandemic. This gap is particularly evident among culturally distinct populations, such as the Meranaw community in Lanao del Sur, where reproductive health behaviors are shaped by deeply rooted cultural norms, religious beliefs, and gender roles (Pangandaman et al., 2025; Sadang et al., 2021).

Meranaw women, as part of a predominantly Muslim population in Southern Philippines, are often influenced by sociocultural expectations that may either facilitate or hinder the adoption of modern contraceptive methods (Pangandaman et al., 2025; Salve et al., 2023). These influences are further complicated during public health emergencies, where mobility restrictions and limited healthcare access intersect with cultural and religious considerations. Understanding how these factors interact to affect FP compliance and, consequently, quality of life is essential for developing context-specific interventions that are both culturally sensitive and effective.

This study offers several important contributions to the existing body of knowledge. First, it shifts the focus from mere access and utilization of family planning services to behavioral compliance, emphasizing how attitudes and practices directly influence quality-of-life outcomes. Second, it provides empirical evidence from a culturally distinct Muslim population, addressing the underrepresentation of indigenous and minority groups in reproductive health research. Third, by situating the analysis within the context of the COVID-19 pandemic, the study contributes to understanding how health behaviors are sustained under conditions of systemic disruption. Finally, integrating socio-demographic and behavioral variables into a predictive model offers a comprehensive, context-sensitive framework for examining determinants of women’s well-being in rural, resource-constrained settings.

This study is anchored in the Health Belief Model (HBM), which posits that individuals’ health behaviors are influenced by their perceptions of susceptibility, severity, benefits, and barriers, as well as cues to action and self-efficacy. In the context of family planning, women’s decisions to comply with contraceptive practices may be shaped by their beliefs about its benefits for health and family well-being, as well as perceived cultural or religious constraints. By applying this framework, the present study examines the extent of family planning compliance and its influence on the quality of life of Meranaw women during the COVID-19 pandemic, while also considering the role of socio-demographic factors as potential predictors of quality-of-life outcomes.

The socio-demographic profile (Table 1) indicates that family planning users were predominantly within the reproductive age group (26–49 years), suggesting that FP services are being accessed primarily by women in their peak fertility period. The high proportion of respondents engaged in informal economic activities or unemployment, combined with low monthly income levels, reflects the socio-economic constraints characteristic of rural settings. The predominance of birth spacing as the primary reason for FP use suggests a preference for managing family size rather than limiting it, which may reflect cultural and religious influences. Additionally, reliance on health facilities and workers as the primary source of information underscores the critical role of primary healthcare systems in promoting FP utilization in geographically isolated areas.

The high level of attitude-related compliance indicates that respondents generally hold favorable perceptions of family planning, particularly regarding its benefits for maternal recovery, birth spacing, and family well-being (Table 2). Notably, strong agreement on partner communication suggests that interpersonal dynamics play a crucial role in shaping compliance behaviors. In contrast, practice-related compliance, while generally high, revealed variability across indicators. High compliance in clinic visits and contraceptive use reflects effective access and utilization of services (Table 3). However, lower compliance in method switching and use of multiple contraceptive options suggests limited flexibility or possible constraints in method availability, awareness, or cultural acceptability. This pattern indicates that while basic adherence is achieved, more complex or adaptive FP behaviors remain less practiced.

The very satisfactory quality of life reported across all domains suggests that respondents perceive their overall well-being positively despite the challenges posed by the pandemic (Table 4). Higher scores in the psychological and relational domains indicate strong emotional resilience and supportive social relationships, which may buffer the adverse effects of socio-economic constraints. Meanwhile, comparatively lower scores in health and functioning may reflect underlying limitations in access to healthcare services or physical well-being, particularly during pandemic-related disruptions.

The regression model demonstrated a high explanatory power (R² = 0.974) (Table 5), indicating that the included variables collectively account for a substantial proportion of the variance in quality of life. However, such a high R² value may also suggest potential multicollinearity among predictor variables. To address this, multicollinearity diagnostics were conducted using the Variance Inflation Factor (VIF) and tolerance values. The results indicated that all VIF values were within acceptable limits (VIF < 10) and tolerance values exceeded 0.10, suggesting that multicollinearity was not a significant concern and that the regression estimates are stable and reliable. The regression analysis indicates that both socio-demographic and family planning-related variables significantly influence quality of life. Notably, age and length of marriage emerged as strong predictors, suggesting that life stage and relationship stability contribute to improved well-being. The positive influence of the number of children and duration of FP use may reflect adaptation to reproductive roles and increased familiarity with FP practices over time. Conversely, the negative association with income, although statistically significant, may indicate underlying socio-economic disparities or reporting inconsistencies that warrant further investigation. The significance of information sources highlights the importance of health communication and access to reliable guidance in shaping health outcomes.

Model Summary: R² = 0.974; F = 1121.387; p < 0.001 *Significant at p < 0.05

This study examined the extent of family planning (FP) compliance and its influence on the quality of life (QoL) among Meranaw women during the COVID-19 pandemic. The findings reveal that respondents demonstrated high levels of compliance in both attitude and practice domains, alongside a very satisfactory quality of life across psychological, relational, socioeconomic, and health dimensions. Furthermore, multiple regression analysis identified several significant predictors of QoL, including age, income, number of children, duration of FP use, and sources of information, indicating that both socio-demographic and behavioral factors contribute to women’s overall well-being.

The high level of compliance observed in this study contrasts with prior research reporting disruptions in access to and utilization of FP services during the COVID-19 pandemic (Kuandyk et al., 2024; VanBenschoten et al., 2022). While many studies emphasized declining contraceptive use due to mobility restrictions and health system strain, the present findings suggest that continuity of care in rural health units may mitigate these adverse effects. This aligns with studies highlighting the importance of maintaining essential health services during public health emergencies (Khoshmaram et al., 2025; Kleine-Bingham et al., 2023).

Moreover, the association between FP compliance and improved quality of life supports existing literature demonstrating that contraceptive use contributes to better health, economic stability, and psychosocial well-being (Finlay et al., 2025; Gaffield & Kiarie, 2022). However, this study extends previous findings by emphasizing that behavioral compliance, rather than mere access or utilization, plays a critical role in influencing QoL outcomes.

The findings can be explained using the Health Belief Model (HBM), which posits that perceived benefits, barriers, and self-efficacy influence health behaviors. In this study, respondents strongly agreed on the benefits of family planning, including birth spacing, maternal recovery, and family well-being. These positive perceptions likely enhanced compliance despite pandemic-related barriers.

Additionally, partner communication emerged as a key factor, indicating that interpersonal relationships significantly influence reproductive health decisions. Supportive spousal dynamics may reinforce positive health behaviors, thereby contributing to improved psychological and relational quality of life.

The influence of socio-demographic factors further reflects life-course and contextual mechanisms. For instance, older age and longer marital duration may be associated with greater stability, experience, and adaptation to reproductive roles. Similarly, prolonged exposure to FP practices may increase familiarity and confidence, reinforcing sustained compliance.

Although educational attainment was not a statistically significant predictor in the regression model, it remains an important contextual factor. Women with higher levels of education may possess better health literacy, enabling informed decision-making regarding contraceptive use and reproductive health (Idris et al., 2023; Panayi et al., 2024).

Cultural and religious influences within the Meranaw community play a complex role in shaping FP behaviors. While certain beliefs may discourage the use of modern contraceptive methods, others promote responsible parenthood and family well-being. This dual influence highlights the importance of culturally sensitive health interventions that align medical recommendations with community values.

Access to healthcare emerged as a critical enabling factor, as evidenced by the high reliance on health facilities and healthcare workers as primary sources of information. In rural settings such as Lanao del Sur, the availability of accessible and trusted healthcare services likely contributed to sustained compliance and positive quality-of-life outcomes, even during the pandemic.

The findings have important implications for healthcare practice and policy. First, strengthening primary healthcare systems is essential to ensure continuous access to family planning services, particularly in geographically isolated and disadvantaged areas. Second, health education programs should emphasize not only access but also sustained behavioral compliance, incorporating strategies that promote positive attitudes and partner involvement.

From a policy perspective, integrating family planning services into emergency preparedness frameworks is crucial to maintaining reproductive health services during crises. Additionally, culturally tailored interventions that respect religious and social norms can enhance the acceptance and effectiveness of FP programs in Muslim and indigenous communities.

This study demonstrates that high levels of family planning compliance are associated with improved quality of life among Meranaw women, even amid the disruptions of the COVID-19 pandemic. Both socio-demographic factors and behavioral aspects of family planning—particularly attitudes, practices, and access to reliable information—were found to influence women’s well-being significantly. The findings highlight the critical role of sustained access to family planning services and the importance of culturally responsive health interventions in rural and Muslim communities. By emphasizing behavioral compliance rather than mere service utilization, this study contributes a more nuanced understanding of how reproductive health practices shape quality of life in resource-constrained settings. Strengthening primary healthcare systems and integrating family planning into emergency preparedness strategies are essential to safeguarding women’s health and well-being during public health crises.

The authors would like to acknowledge the contributions of their colleagues in the College of Health Sciences and health professionals in the Rural Health Units at Lanao del Sur. Special acknowledgments are due to the Meranaw women FP users.

The data supporting the results of this study were gathered through field-based observations and have been recorded by the researcher. Although the dataset is not openly accessible, it can be shared by the corresponding author upon reasonable and well-justified request.

The research was conducted without external funding and was supported entirely by the researchers' personal resources.

The authors hereby declares that this research is free from conflicts of interest with any party.