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Modern contraceptive use among women in need of family planning in India an analysis of the inequalities related to the mix of methods used

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Fernanda Ewerling, Lotus McDougal, Anita Raj, Leonardo Z Ferreira, Cauane Blumenberg, Divya Parmar, Aluisio J D Barros

Original languageEnglish
Article number173
Pages (from-to)173
JournalReproductive Health
Volume18
Issue number1
DOIs
Published21 Aug 2021

Bibliographical note

Funding Information: This paper builds on analysis included in the WHO Universal Health Coverage Global Monitoring Report 2019. This report was reviewed by many experts including from the WHO Regional Office in India. The findings were also presented at a Seminar in WHO Geneva on 2 Dec 2019 and at a side event of the United Nations General Assembly 74 UHC High Level Meeting on 24th?Sept 2019, which had panel members and attendees from India. The authors would also like to thank the reviewers of this report, participants of the seminars, as well as colleagues from the International Institute for Population Sciences (IIPS) for their insights into NFHS-4 data and contraceptive use preferences and dynamics in India. We would also like to thank Veronica Magar (Gender, Equity and Human Rights Team, World Health Organization (WHO), Geneva, Switzerland) for her valuable contributions to this study and Cintia Borges (International Center for Equity in Health) for assisting with the graphs design. Funding Information: The study was funded by the World Health Organization, Bill & Melinda Gates Foundation [Grant Number: OPP1199234] and Wellcome [Grant Number: 101815/Z/13/Z]. The funders of the study had no role in the data analysis, data interpretation, or writing of the paper. The corresponding author had full access to all the data and had final responsibility for the decision to submit it for publication. Publisher Copyright: © 2021, The Author(s). Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

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Abstract

OBJECTIVE: To evaluate the type of contraceptives used by women in need of family planning in India and the inequalities associated with that use according to women's age, education, wealth, subnational region of residence and empowerment level.

METHODS: Using data from the Indian National Family and Health Survey-4 (2015-2016), we evaluated the proportion of partnered women aged 15-49 years with demand for family planning satisfied (DFPS) with modern contraceptive methods. We also explored the share of each type of contraception [short- (e.g., condom, pill) and long-acting (i.e., IUD) reversible contraceptives and permanent methods] and related inequalities.

RESULTS: The majority (71.8%; 95% CI 71.4-72.2) of women in need of contraception were using a modern method, most (76.1%) in the form of female sterilization. Condom and contraceptive pill were the second and third most frequently used methods (11.8% and 8.5%, respectively); only 3.2% reported IUD. There was a nearly linear exchange from short-acting to permanent contraceptive methods as women aged. Women in the poorest wealth quintile had DFPS with modern methods at least 10 percentage points lower than other women. We observed wide geographic variation in DFPS with modern contraceptives, ranging from 23.6% (95% CI 22.1-25.2) in Manipur to 93.6% (95% CI 92.8-94.3) in Andhra Pradesh. Women with more accepting attitudes towards domestic violence and lower levels of social independence had higher DFPS with modern methods but also had higher reliance on permanent methods. Among sterilized women, 43.2% (95% CI 42.7-43.7) were sterilized before age 25, 61.5% (95% CI 61.0-62.1) received monetary compensation for sterilization, and 20.8% (95% CI 20.3-21.3) were not informed that sterilization prevented future pregnancies.

CONCLUSION: Indian family planning policy should prioritize women-centered care, making reversible contraceptive methods widely available and promoted.

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