contraceptive practices and unmet need among young ... - MedIND

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Chhattisgarh and Madhya Pradesh. .... Madhya Pradesh, have been selected. ..... Rewa. 35.0. 177. Bilaspur. 33.7. 190. Sagar. 38.8. 188. Dantewada. 20.2. 84.

CONTRACEPTIVE PRACTICES AND UNMET NEED AMONG YOUNG CURRENTLY MARRIED RURAL WOMEN IN EMPOWERED ACTION GROUP (EAG) STATES OF INDIA RANAJIT SENGUPTA AND ARPITA DAS

Introduction India is the first country in the world to launch Family Planning Programme in 1952 (NPP, 2000). The central premise and rationale of Family Planning Programme was to enable individuals, particularly, women and couples to exercise control over their own fertility. However, in the early 60s, as the Government gradually became more concerned about curbing the rapid population growth, the national perspective overrides the individual needs. Population explosion increasingly caused worry to the Government about their ability to provide adequate level of health, education and other social services. Many approaches and strategies to improve the programme and to increase the contraceptive prevalence rate had been adopted. The Fifth Five Year Plan (1974-78) gave huge emphasis on sterilization, but due to the approach

adopted for the programme, it suffered a serious setback in 1977. It became controversial and almost collapsed in 1977-78. In the ‘80s, India adopted the “cafeteria approach” to raise the prevalence of contraceptive methods among eligible couples. Despite this, the total number of women not practicing any form of contraception has hardly declined at all mainly due to the enormous increase in the number of women in the reproductive age group.1 According to the Census of India (2001), there are 2, 51,431,886 women (51 percent of total women) in the reproductive age (15- 49 years), 70 percent of them reside in rural areas. Among the rural women in reproductive age group, 36 percent are in the age group of 15-24 years and 18 percent are adolescents (below 20 years), 33 percent of the women aged 15-24 years are from eight Empowered Action Group (EAG) states, namely Uttaranchal, Rajasthan,

Ranajit Sengupta is presently working in Technical Support Group (Condom Promotion) - NACO as Research Manager in Delhi and Arpita Das is Doctoral Fellow (JRF, GoI) at International Institute for Population Sciences (IIPS), Govandi Station Road, Deonar, Mumbai - 400 088.

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Uttar Pradesh, Bihar, Jharkhand, Orissa, Chhattisgarh and Madhya Pradesh. More than half of all the currently married women, aged 15-44 years are exposed to their first cohabitation at age less than 18 years and have two to three children by the age of 24 years (RCH-II). Many of them want to postpone or limit childbirth but are not using any kind of contraceptives. Besides, in the Indian context a woman is not empowered to take decisions on family planning or use of health care. Thus, there is wide gap in contraceptive knowledge, attitudes, and practices (KAP) between women’s reproductive intentions and contraceptive behaviours. Since the 1960s, survey data have indicated that substantial proportions of women who have wanted to stop or delay childbearing have not practiced contraception. This discrepancy or gap is referred to as the “unmet need” for family planning and has been defined and measured variously. Unmet need has been an important measure in family planning policy. As pointed out by Ashford,2 “This gap between women’s preferences and actions inspired many governments to initiate or expand family planning programs in order to reduce unintended pregnancies and lower the fertility rate. The term “unmet need” was coined in the late 1970s and has served ever since to gauge family planning needs in less developed countries.”2 Unmet need for family planning, therefore, refers to the proportion of married, fecund women who desire to space or limit their births but are not using contraception. Unmet need for family planning also refers to the non-use of contraception among women who would like to regulate their fertility, measured as the proportion of currently married women of reproductive age not using contraception but wishing either to postpone the next wanted birth or to prevent unwanted childbearing after having achieved their desired number of children.

2

Approximately 120 million fecund women in the world are not using contraception. Almost half of women in low prevalence countries lack knowledge about contraceptives or have religious reservations about using them, while in countries of high contraceptive prevalence, health concerns are the major reason for non-use, followed by infrequent sex, and lack of knowledge.3 A study by Torres and Singh4 among the U.S population of Hispanic origin revealed that the Hispanic women of adolescent groups were least likely to use a contraceptive method at their first intercourse. A high level of unmet need for contraception persists among currently married women in South Asia. At least 1 in 5 currently married women in the countries surveyed want to stop or delay childbearing, but are not using contraception. 5 The currently married Young women (15-24 years) in India form one of the largest groups with an unmet need for reproductive health services.6 Number of living sons, child loss, rural urban residence, education, media exposure and accessibility of family planning facility plays significant role in unmet need of Uttar Pradesh.7 Many scholars infer that the important reasons for non-use of contraception are lack of knowledge,8 fear of side effects, and social and familial disapproval, 9 poor quality of care, and lack of choice in contraception available. 10 Robey and others11 viewed that lack of access to service points as a primary reason for nonuse among the people, motivated for using. The result of the study by Puri, Garg and Mehra12 among married eligible women of 15-45 year in Slum clusters in urban Delhi revealed that opposition from husband’s/ families and male child preference was cited as the main reason for non use of contraception. Educated women have lower unmet need, but the husband’s education has no significant effect upon unmet need.

The Journal of Family Welfare

Unmet contraceptive need rises as age and parity increase. Rural women have greater probability of having unmet contraceptive needs than urban women.13 Early age at marriage opens up a wider span of sexual exposure to the females and it is quite possible that most of them have two to three children by the age of twenty-four. “Too early, too frequent, too many” reproductive pattern leads to 33 percent births with an interval of less than 24 months, which results in high infant mortality.14 Premature babies with low birth weight, unwanted pregnancy terminated with induced abortion, maternal and child loss, pregnancy wastage, vulnerable health condition including reproductive morbidity are some other well-established consequences of conception at early ages. In this regard, it is relevant to pay extra attention to contraceptive behavior of currently married rural women between 15-24 years of age, simply because proper knowledge and high prevalence of appropriate use of contraceptive methods may protect this sensitive age group (1524) from unplanned pregnancy, early child bearing and high reproductive morbidity. But there is dearth of studies, which address the issue of contraceptive practice and unmet need for contraception among the young women, especially residing in rural areas. The main objective of this study is to examine the unmet need among the young currently married rural women in the EAG states of India. The specific objectives to: examine the differentials in the practice of various contraceptive methods; study the reasons and differentials of unmet need for contraception and find out the factors influencing unmet need for contraception for both spacing as well as limiting.

and Child Health Programme. The survey was conducted during the period 20022004 in 593 districts of India. It covered a representative sample of 1000 households in each district. A total of 6,20,107 households were selected and out of those, around two thirds were rural households. For the purpose of the present analysis, data pertaining to 8 EAG states of DLHS has been used. The Empowered Action Group states (EAG States), which include Uttaranchal, Rajasthan, Uttar Pradesh, Bihar, Jharkhand, Orissa, Chhattisgarh and Madhya Pradesh, have been selected. The EAG states consist of 270,063 households. As the study is focussed only on rural young women; thus, for the study purpose, the urban women have been excluded and currently married women in the age group 15-24 have been selected. TABLE 1 Distribution of currently married young women in the EAG states, DLHS-2, 2002-04 State

Frequency

Percent

Uttaranchal Rajasthan Uttar Pradesh Bihar Jharkhand Orissa Chhatisgarh Madhya Pradesh

1820 8631 16054 9704 4043 4915 2764 8964

3.2 15.2 28.2 17.1 7.1 8.6 4.9 15.8

Total

56895

100

Methodology

To study differentials in practice of different contraceptive methods in EAG states, bi-variate analysis has been carried out according to different socio-economic characteristics and availability-accessibility of health facilities. Multi-variate analysis is done to quantify the variation in unmet need for different socio economic and background characteristics as well as availability-accessibility of health facilities.

The data for this analysis has been taken from District Level Household Survey (DLHS) under the Reproductive

The unmet need for spacing has been calculated by considering those currently married women, who are not pregnant,

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are menstruating, had not gone for hysterectomy, and who want more children after two years or more but currently not practicing any family planning methods. Women who are not sure about when to have (or whether to have) the next child have been included in the calculation of unmet need for spacing. The unmet need for limiting the child birth has been calculated by considering those currently married women, who are not pregnant, are menstruating, not gone for hysterectomy, and do not want any more children but currently not practicing any family planning methods. Total unmet need has been calculated as the sum of unmet need for spacing and unmet need for limiting.

categories, namely sterilization (includes female sterilization, tubectomy, laparoscopy, male sterilization, vasectomy and non scalpel vasectomy), modern methods for spacing between two successive births (intrauterine devices-IUD, oral contraceptive pills-OCP, condom, spongeToday, injectable) and traditional methods (rhythmic, withdrawal, and ‘other traditional methods’) of family planning. In most of the EAG states, Muslim women have the least acceptance for sterilization. Very less proportion of young couple (less than 5 percent) among the schedule tribe (ST) population are sterilized in the states of Bihar, Jharkhand, Orissa and Rajasthan. Sterilization acceptance is highest among those couple, where only husbands are literate. Sterilization acceptance does not follow any specific pattern with respect to Standard of Living Index (SLI). With the increase in household SLI, the sterilization acceptance decreases in Orissa, Uttaranchal and Uttar Pradesh (Table 2).

Results And Discussion Practice of different methods of contraception Different types of contraceptive methods have been grouped into three major

TABLE 2 Use of different types of contraceptive methods among currently married rural women aged 15-24 years in EAG states, DLHS-II Category



Uttaranchal Sterili- Modern zation spacing

Rajasthan Tradi- tional

Sterili- Modern zation spacing

UP Tradi- tional

Sterili- Modern zation spacing

Bihar Tradi- tional

Sterili- Modern zation spacing

Traditional

Religion

Hindu

2.5

8.3

2.7

7.3

5.7

3.0

3.1

5.6

6.5

3.5

2.3



Muslim

11.5

2.9

3.2

6.4

2.8

0.6

5.6

4.7

0.7

2.1

2.5

2.2



Others

5.6

16.7

5.6

11.1

21.5

2.1

0.0

17.9

7.1

0.0

0.0

0.0

Caste

SC

4.0

4.8

3.2

6.8

4.7

2.6

2.4

3.7

6.4

2.0

1.4

2.1



ST

2.4

11.9

4.8

4.7

5.2

3.0

3.7

2.1

7.4

1.2

1.7

1.7



OBC

0.9

10.2

2.7

8.2

6.0

3.1

2.9

5.6

6.1

3.5

2.1

2.0



Others

2.3

8.9

2.7

6.6

8.2

2.9

2.8

8.3

6.4

3.8

3.9

3.2

Couple’s education

Both illiterate

2.1

4.3

2.8

6.4

3.1

2.4

2.1

2.7

5.4

2.2

0.9

1.8



Only husband lit.

5.5

4.9

4.1

8.0

3.9

2.8

3.4

4.3

6.4

3.5

1.4

1.8



Only wife literate

0.0

4.2

4.2

7.3

3.4

2.2

2.2

4.8

3.9

2.8

0.8

2.4



Both literate

1.6

10.2

2.4

6.3

12.3

3.7

2.5

9.3

7.0

4.0

4.7

3.0

Standard of Living Index

Low

3.1

5.1

3.0

6.2

3.6

2.8

2.8

3.6

6.2

2.7

1.4

2.0



Medium

1.6

9.2

3.0

8.4

7.5

2.9

2.7

7.8

6.0

4.9

4.5

2.8



High

1.5

22.3

1.0

8.3

15.3

3.8

2.6

15.5

7.8

4.6

9.4

4.6

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The Journal of Family Welfare

Category



Uttaranchal Sterili- Modern zation spacing

Rajasthan Tradi- tional

Sterili- Modern zation spacing

UP Tradi- tional

Sterili- Modern zation spacing

Bihar Tradi- tional

Sterili- Modern zation spacing

Traditional

Son ever born

3

15.0

2.5

2.5

16.8

5.3

8.4

21.3

Child loss

No

2.2

8.6

2.6

7.0

6.2

3.1

2.6

5.7

6.2

3.1

2.4

2.3



Yes

5.0

8.0

5.0

8.2

4.5

1.9

3.6

4.8

6.5

3.7

1.1

1.9

Category



Jharkhand Sterili- Modern zation spacing

Availability of health facility No 2.7 Yes 2.1

Orissa Tradi- tional

Sterili- Modern zation spacing

Chhattisgarh Tradi- tional

Sterili- Modern zation spacing

MP Tradi- tional

Sterili- Modern zation spacing

Traditional

6.4 10.2

2.1 3.3

6.8 7.2

4.5 6.4

3.0 2.9

2.6 2.8

5.0 5.8

6.3 6.3

3.4 3.1

1.7 2.5

2.0 2.3

Accessibility of any health facility No 1.4 4.5 Yes 2.7 9.5

2.1 2.9

7.7 7.0

7.7 6.0 3.0

0.9 2.9

5.7 5.5

3.3 6.7

1.9 3.6

1.0 2.5

1.8 2.3

Religion Hindu Muslim Others

5.2 1.2 0.9

3.2 4.3 1.8

1.8 1.5 1.8

5.0 3.6 4.0

8.8 16.4 10.3

8.0 9.1 4.8

6.8 5.9 4.0

3.9 5.9 20.0

2.7 5.9 4.0

8.9 5.6 9.0

5.1 7.5 10.3

1.9 2.3 0.0

Caste SC ST OBC Others

4.9 2.4 5.2 5.0

3.1 2.4 3.6 5.0

1.7 1.2 2.0 2.2

5.5 3.4 5.6 6.6

7.3 4.7 10.6 18.2

9.2 6.3 8.5 8.6

8.1 4.7 8.7 2.1

3.2 3.6 4.2 8.3

2.3 2.4 3.0 4.1

5.9 8.3 10.3 8.8

4.0 2.5 6.2 8.1

2.1 1.2 2.0 2.4

Couple’s education Both illiterate Only husband lit. Only wife literate Both literate

3.7 5.2 1.9 4.8

0.9 1.9 2.8 7.5

1.1 1.3 1.9 3.0

6.3 5.4 5.4 3.7

3.2 6.2 8.4 14.6

5.9 7.9 5.9 9.6

6.4 7.6 6.5 6.5

1.7 2.5 3.7 6.1

3.1 3.4 0.9 2.4

8.6 10.2 5.6 8.0

2.2 4.0 3.7 9.1

1.7 1.9 2.9 2.0

Standard of Living Index Low 3.9 Medium 8.0 High 4.1

2.2 8.3 14.4

1.3 3.6 9.3

5.1 4.7 4.0

6.6 15.3 25.8

7.4 9.3 11.6

6.8 7.4 3.0

2.6 6.6 17.8

2.6 2.6 7.9

8.2 10.5 8.6

2.6 8.7 19.9

1.9 1.8 2.6

Son ever born 3

1.5 20.2 26.7

3.3 4.1 31.3

1.5 3.3 6.3

2.4 22.1 6.3

8.5 11.5 71.4

7.6 10.2 33.3

3.2 28.2 3.3

4.1 4.0

2.3 5.9

3.6 35.0

5.5 3.9

1.9 2.0

4.4 5.1

3.5 2.3

1.7 2.3

4.9 5.3

8.9 9.0

7.9 8.1

6.4 9.8

4.3 1.8

2.7 3.2

8.9 8.4

5.5 3.0

2.0 1.5

Availability of health facility No 3.3 Yes 5.2

3.0 3.6

1.3 2.1

5.4 4.8

7.4 9.4

7.8 7.9

8.8 6.3

4.2 4.0

4.0 2.5

8.5 8.8

4.4 5.4

1.8 1.9

2.4 1.7 5.2

12.9 8.8

6.0 8.1

8.1 6.7

4.2 4.1

5.4 2.5

7.6 9.0

2.8 5.5

1.4 2.1

Child loss No Yes

Accessibility of any health facility No 3.6 2.6 Yes 4.7 3.3

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Sterilization acceptance shows steady increase with the increase in the number of son ever born but it was found to be low among women who have experienced child loss. Women, who access any kind of health facility throughout the year, have higher acceptance of sterilization compared to those who did not access a health facility.

have any child loss. Use of modern spacing method increased with availability of health facility in the village.

In Jharkhand, young women from other religious groups showed the least acceptance of (2%) any modern spacing method of contraception. On the other hand, the percentage was highest among Muslims in Orissa (16%). Acceptance of modern method for spacing was lowest (1%) among the women in Jharkhand where couples were illiterate. The practice of modern spacing methods increases from low to medium SLI category but the increase is pretty steep and doubles among women with a high standard of living index. Among young women having at the most three sons, practice of modern spacing method increases with increase in number of sons ever born. But in case of more than 3 sons, acceptance decreases in most of the EAG states. Modern spacing was found to be less prevalent among women with one or more child loss than those who did not

Unmet need for contraception

Traditional method is most prevalent among the Muslims of Orissa (9%), though it does not differ much by other socioeconomic variables.

Table 3 shows the extent of unmet need in different EAG states. Jharkhand (39%), Bihar (37%) and Uttar Pradesh (35%) are top three states with higher unmet need. In Uttaranchal, unmet need for contraception is 30 percent, and ranges from 18 in Chamoli district to 38 percent in Hardwar district. In Orissa, it ranges from 9 percent to 36 percent. Rajasthan has highest unmet need in Dungarpur district (42%) and the lowest of 8 percent in Hamumangarh district. In Chhattisgarh, it ranges from 16 percent in Dantewara to 37 percent in Janjgir-Champa. West Nimar is the district with lowest unmet need (10%) in Madhya Pradesh. Rae Bareli of Uttar Pradesh, Sheohar and Katihar of Bihar; Gumla, Pashchimi Singhbhum and Kodarma in Jharkhand are the districts where unmet need is more than fifty percent.

TABLE 3 Unmet need for contraception among rural young currently married women: EAG States, DLHS-II    State/District Uttaranchal Almora Bageshwar Chamoli Champawat Dehradun Garhwal Hardwar Nainital Pithoragarh Rudraprayag Tehri Garhwal Udham Singh Nagar

6

Total Total Unmet   State/District Women Need 29.5 35.8 25.2 21.1 25.2 35.5 25.9 37.5 36.9 30.7 32.6 27.0 27.5

1820 148 139 114 163 76 139 128 141 140 172 141 167

Bihar Araria Aurangabad Banka Begusarai Bhagalpur Bhojpur Buxar Darbhanga Gaya Gopalganj Jamui Jehanabad

Total Unmet Need

Total Women

37.3 38.9 30.5 40.1 38.5 39.7 34.5 36.9 46.7 36.9 29.5 30.7 43.1

9704 239 315 252 244 232 249 279 270 268 302 280 218

The Journal of Family Welfare

   State/District Uttarkashi Rajasthan Ajmer Alwar Banswara Baran Barmer Bharatpur Bhilwara Bikaner Bundi Chittaurgarh Churu Dausa Dhaulpur Dungarpur Ganganagar Hamumangarh Jaipur Jaisalmer Jalor Jhalawar Jhunjhunun Jodhpur Karauli Kota Nagaur Pali Rajsamand Sawai Madhopur Sikar Sirohi Tonk Udaipur Uttar Pradesh Agra Aligarh Allahabad Ambedaker Nagar Auraiya Azamgarh Baghpat Bahraich Ballia

Total Total Unmet   State/District Women Need 25.0 25.8 33.0 17.9 29.5 34.2 34.8 22.0 28.7 29.9 28.1 41.2 26.9 20.6 23.3 42.3 11.2 10.3 18.6 35.9 21.5 31.2 33.3 15.1 17.0 18.5 28.6 20.5 24.9 18.2 28.4 40.3 13.4 26.4 34.5 28.3 24.2 27.2 39.7 29.5 43.1 20.9 39.3 39.8

Vol. 58, No.1, June - 2012

152 8631 215 290 302 234 287 328 279 304 267 284 320 248 245 222 285 302 172 351 317 260 270 311 265 178 259 254 205 242 331 243 277 284 16054 127 194 243 277 176 320 196 285 246

Kaimur (Bhabua) Katihar Khagaria Kishanganj Lakhisarai Madhepura Madhubani Munger Muzaffarpur Nalanda Nawada Pashchim Champaran Patna Purba Champaran Purnia Rohtas Saharsa Samastipur Saran Sheikhpura Sheohar Sitamarhi Siwan Supaul Vaishali Jharkhand Bokaro Chatra Deoghar Dhanbad Dumka Garhwa Giridih Godda Gumla Hazaribagh Kodarma Lohardaga Pakaur Palamu Pashchimi Singhbhum Purbi Singhbhum Ranchi Sahibganj

Total Unmet Need

Total Women

32.4 50.9 33.9 46.5 31.3 40.9 33.5 40.6 37.7 30.1 46.1 32.0 45.3 40.9 23.2 29.0 42.5 42.0 31.4 38.4 52.0 38.1 38.4 23.7 39.4 38.5 36.7 48.5 35.5 28.7 33.2 37.3 31.8 31.5 61.5 45.6 51.8 49.7 25.5 23.0 55.4 42.3 35.2 34.3

238 234 224 172 262 235 278 219 204 249 284 419 179 291 190 245 294 441 261 224 273 265 258 295 322 4043 215 262 234 174 223 271 314 381 143 250 282 177 208 213 157 123 165 251

7

   State/District

Total Total Unmet   State/District Women Need

Total Unmet Need

Total Women

Balrampur Banda Barabanki Bareilly Basti Bijnor Budaun Bulandshahar Chandauli Chitrakoot

35.7 28.5 35.5 34.4 32.2 28.8 33.0 32.2 28.9 25.3

266 239 242 180 264 125 203 180 311 316

Orissa Anugul Balangir Baleshwar Bargarh Baudh Bhadrak Cuttack Debagarh Dhenkanal

23.0 32.7 21.6 23.9 21.3 23.0 28.9 16.2 28.7 15.7

4915 199 185 197 164 174 142 117 171 159

Deoria Etah Etawah Faizabad Farrukhabad Fatehpur Firozabad Gautam Buddha Nagar Ghaziabad Ghazipur Gonda Gorakhpur Hamirpur Hardoi Hathras Jalaun Jaunpur Jhansi Jyotiba Phule Nagar Kannauj Kanpur Dehat Kanpur Nagar Kaushambi Kheri Kushinagar Lalitpur Lucknow Maharajganj Mahoba Mainpuri Mathura Mau Meerut Mirzapur

22.0 26.3 28.5 38.1 22.2 31.6 36.8 34.2 37.9 38.1 45.5 34.8 33.5 33.3 25.8 27.2 43.0 31.7 44.4 33.1 36.1 32.7 41.6 37.1 30.5 35.0 36.7 39.3 27.3 30.3 31.8 36.5 27.5 34.8

286 190 172 239 153 231 185 161 116 307 299 296 215 207 186 268 344 246 180 172 244 55 226 286 295 323 109 308 198 178 245 249 138 276

Gajapati Ganjam Jagatsinghapur Jajapur Jharsuguda Kalahandi Kandhamal Kendrapara Kendujhar Khordha Koraput Malkangiri Mayurbhanj Nabarangapur Nayagarh Nuapada Puri Rayagada Sambalpur Sonapur Sundargarh Madhya Pradesh Balaghat Barwani Betul Bhind Bhopal Chhatarpur Chhindwara Damoh Datia Dewas Dhar Dindori

17.6 25.9 14.8 24.8 18.6 20.1 22.8 25.9 35.7 25.7 22.3 13.3 29.9 21.9 27.8 21.8 20.3 22.6 25.7 22.4 16.2 25.2 24.6 17.3 29.4 40.0 23.3 41.8 21.5 25.1 25.9 25.8 17.6 29.8

182 201 108 137 129 184 167 116 154 140 188 256 187 228 169 179 128 155 113 156 130 8964 138 283 153 195 73 194 186 175 174 279 272 238

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The Journal of Family Welfare

   State/District

Total Total Unmet   State/District Women Need

Total Unmet Need

Total Women

Moradabad Muzaffarnagar Pilibhit Pratapgarh Rae Bareli Rampur Saharanpur Sant Kabir Nagar Sant Ravidas Nagar Shahjahanpur

36.8 23.6 33.2 38.3 51.3 37.2 37.3 34.0 36.3 41.0

212 195 226 290 195 180 150 235 380 173

East Nimar Guna Gwalior Harda Hoshangabad Indore Jabalpur Jhabua Katni Mandla

26.0 24.1 32.4 20.1 14.8 19.8 35.5 26.0 28.7 24.0

223 261 102 174 169 106 110 223 174 183

Shrawasti Siddharthnagar Sitapur Sonbhadra Sultanpur Unnao Varanasi Chhatisgarh Bastar Bilaspur Dantewada Dhamtari Durg Janjgir-Champa Jashpur Kanker Kawardha Korba Koriya Mahasamund Raigarh Raipur Rajnandgaon Surguja

34.1 43.1 48.0 35.1 42.9 30.8 32.3 26.6 36.7 33.7 20.2 22.4 29.6 37.3 23.5 26.8 20.0 25.1 28.6 21.3 20.5 30.4 29.3 21.1

279 262 271 279 282 221 251 2764 177 190 84 165 162 153 136 142 250 183 220 211 132 138 174 247

Mandsaur Morena Narsimhapur Neemuch Panna Raisen Rajgarh Ratlam Rewa Sagar Satna Sehore Seoni Shahdol Shajapur Sheopur Shivpuri Sidhi Tikamgarh Ujjain Umaria Vidisha West Nimar

20.5 11.5 26.0 18.7 23.0 27.3 24.3 18.5 35.0 38.8 25.7 23.9 23.4 30.2 23.9 17.7 18.1 32.9 28.9 20.2 40.4 31.0 12.2

224 200 235 230 178 187 239 238 177 188 187 226 184 222 218 147 210 231 204 242 228 255 229

Table 4 indicates that the level of unmet need for spacing is relatively high as compared to that of limiting. The total unmet need for contraception was found to be maximum among Muslim women in Bihar (42%), among ST women in Jharkhand the total unmet need is the highest (43%). In most of the EAG states the maximum proportion of total unmet need is concentrated among illiterate couples. Women with low SLI was

Vol. 58, No.1, June - 2012

found to have higher proportion of total unmet need for contraception as compared to women with medium and high SLI. Unmet need to limit birth increases among women with at least one child loss. With increasing number of sons ever born, the highest percentage of unmet need was for limiting birth methods. The unmet need did not differ much with availability and accessibility of any health facility in the village.

9

TABLE 4 Unmet need for different contraceptive methods among currently married rural women aged 15-24 years in EAG States, DLHS-II Category





Uttaranchal

Rajasthan

UP

Bihar

Spacing Limiting Spacing Limiting Spacing Limiting Spacing Limiting N = 1820

N = 8631

N = 16054

N = 9704

Religion Hindu

22.2

6.9

18.8

7.1

26.0

8.1

27.3

9.4

Muslim

25.9

12.0

24.2

4.4

30.7

7.6

33.3

8.8

Others

15.8



6.7

4.7

16.7

3.3

30.0



27.3

6.7

17.4

7.2

28.0

7.2

28.8

9.0

Caste SC ST

7.1

11.9

19.5

8.6

24.2

7.9

28.9

9.2

OBC

27.0

9.0

18.5

6.2

26.5

8.3

27.7

9.2

Others

21.1

6.7

20.9

7.0

24.8

8.2

27.8

9.9

Both Illiterate

25.9

13.3

21.1

7.9

28.2

8.1

26.9

10.2

Only husband literate

22.2

8.4

18.2

6.8

26.9

8.3

29.9

8.9

Only wife literate

20.0

8.0

19.3

6.1

30.1

7.5

26.9

7.1

Both Literate

22.1

6.1

17.9

6.3

24.5

7.6

28.0

9.0

Low

21.7

7.1

20.1

7.3

27.7

8.0

28.7

9.1

Medium

25.0

7.4

17.4

6.7

24.8

8.2

25.8

10.0

High

16.6

6.3

16.5

5.7

22.0

7.6

23.9

10.5

3

22.5

7.2

9.8

41.5

16.5

34.0

20.4

36.7

No

19.8

6.9

19.2

6.5

26.5

7.5

28.1

8.9

Yes

21.4

7.1

16.4

10.6

26.5

11.2

27.2

12.9

No

23.1

7.2

20.0

7.2

25.6

7.5

27.3

8.9

Yes

23.2

8.0

18.6

6.8

26.8

8.1

28.3

9.5

Couple’s Education

SLI

Son ever born

Child loss

Availability of health facility

Accessibility of any health facility No

21.6

7.0

15.4

11.5

23.8

7.2

28.3

9.0

Yes

22.2

6.9

18.9

6.9

26.8

7.9

27.4

9.4

10

The Journal of Family Welfare

Category





Uttaranchal

Rajasthan

UP

Bihar

Spacing Limiting Spacing Limiting Spacing Limiting Spacing Limiting N = 4043

N = 4915

N = 2764

N = 8964

Religion Hindu Muslim Others

29.6 31.3 33.6

9.0 6.9 2.7

15.4 15.5 10.2

7.6 10.3 9.4

20.1 29.4 16.0

6.4 – 8.0

17.2 19.3 16.5

7.9 10.3 8.9

Caste SC ST OBC Others

31.0 32.7 29.2 25.2

8.7 9.9 7.8 8.1

13.8 16.2 15.7 13.8

7.7 7.2 8.3 7.3

22.6 19.5 19.8 22.3

8.0 5.9 6.5 5.4

17.2 17.3 16.5 19.2

7.3 8.0 8.4 7.6

Couple’s Education Both Illiterate Only husband lit. Only wife literate Both Literate

31.9 30.1 26.2 28.0

7.6 8.7 5.6 9.5

15.1 15.7 14.8 18.2

7.0 9.7 7.0 7.2

20.2 20.3 20.0 20.1

6.2 6.8 9.1 6.0

17.7 16.2 19.3 17.7

7.6 8.5 7.3 7.8

SLI Low Medium High

31.3 23.0 25.0

8.3 9.9 6.0

15.7 13.8 13.2

8.2 6.2 5.4

20.2 20.1 20.6

6.6 6.0 4.9

18.3 15 15.3

7.9 8.3 7.3

Son ever born 3

30.7 26.0 18.8

5.0 27.0 37.5

15.7 12.8 –

5.6 22.0 25.0

21.1 14.2 14.3

3.9 22.3 14.3

18.6 11.1 3.3

5.5 20.3 33.3

Child loss No Yes

30.1 29.0

8.0 12.3

15.5 13.5

7.5 9.1

20.5 17.1

6.3 7.7

17.3 16.9

7.6 10.3

Availability of health facility No Yes

30.5 29.6

8.6 8.4

13.7 15.8

8.3 7.5

18.5 20.5

7.2 6.2

17.0 17.4

7.5 8.1

Accessibility of any health facility No 28.9 Yes 29.9 Total 30.0

8.7 8.6 8.5

7.4 15.5 15.3

11.6 7.6 7.7

15.9 20.3 20.2

8.4 6.1 6.4

19.2 16.5 17.3

8.0 7.8 8.0

Reasons for not using contraception Ta b l e 5 g i ve s t h e p e r c e n t a g e o f wo m e n g i v i n g va r i o u s r e a s o n s f o r nonuse of spacing methods for contraception. Important reasons we r e h u s b a n d s ’ o p p o s i t i o n , h e a l t h related problems, lack of knowledge on proper contraceptive methods. In Bihar Jharkhand and M.P among all these reasons, opposition by husband

Vol. 58, No.1, June - 2012

was reported as the most prevalent reason for not using contraception. Chhatisgarh, Uttaranchal and U.P were the first three states where women not using contraceptives was because of health related problem. Women in Madhya Pradesh and Jharkhand stated lack of knowledge was one of the most frequently reported reasons for not using contraceptives.

11

TABLE 5 Reason for not using contraceptive method among currently married rural women aged 15-24 years having an unmet need for contraception in EAG states, DLHS-II Reasons

EAG States Uttaranchal Rajasthan

UP

Bihar

Jharkhand

Orissa

Chhattisgarh

MP

Knowledge &Misconception

Lack of knowledge

5.4

4.5

4.1

2.4

5.6

3.9

7.2

10.3



Afraid of sterilization

2.0

3.1

2.3

2.3

3.9

0.7

4.1

2.7



Cannot work after



Sterilization

0.6

1.8

0.3

1.0

1.5

0.4

0.8

0.5

Opposition

Against religion

1.3

1.2

3.9

5.4

5.4

1.5

0.8

1.0



Opposed to family planning

0.2

1.3

1.4

0.7

1.0

1.6

0.7

1.0



Husband opposed

4.1

4.8

7.8

28.0

25.5

6.1

7.4

8.6



Other people opposed

1.7

3.6

3.2

13.4

6.8

2.6

6.0

7.7

Method related problems

Do not like existing methods

2.6

1.8

1.8

0.7

0.5

1.1

1.1

1.1



Costs too much

1.5

0.6

1.2

2.4

2.9

1.5

1.1

0.8



Hard/Inconvenient to get



Method

0.9

1.3

1.9

1.7

1.5

1.9

0.7

2.4



Inconvenient to use method

0.4

0.7

0.5

0.6

0.5

1.0

1.8

1.0

Health related problems

Worry about side effects

0.9

0.9

0.8

2.3

2.8

2.3

0.8

1.4



Health does not permit

14.2

4.8

8.1

5.6

7.9

7.2

17.2

5.5



Difficult to become pregnant



Other reasons

3.7

5.0

3.0

6.8

6.0

3.0

7.9

4.6

60.5

64.4

60.0

26.8

28.2

65.2

42.5

51.4

Determinants of unmet need for contraception Age of women, educational level of the couples, sons ever born, child loss, religion, SLI, households having electronic media and visit by FP workers are highly significant factors influencing the unmet need for spacing. State-wise difference were found. With increase in age, the unmet need for spacing increased significantly. Among currently married rural young (1524), Muslim women of EAG states, unmet need for spacing increased significantly by 23.5 percent compared to Hindu women. As the SLI rises, the unmet need for spacing reduced by 11 percent for medium and 16.5 percent for high SLI group. The unmet need for spacing reduced significantly by six percent among literate couples husbands, and illiterate women. With increasing

12

number of sons ever born, unmet need for spacing increased by 15 percent. The unmet need decreased by nine percent for women with at least one child loss. The visit by FP worker raised the unmet need for spacing by nine percent. As age increases, the unmet need for spacing increases significantly. Among Muslim women and women from other religions, the unmet need for limiting reduced significantly by 23 percent and 32 percent respectively as compared to Hindu women. With increased in educational level of the couples, the unmet need for limiting increased significantly. In medium SLI group, the unmet need to limit increased by 11 percent, compared to women with low SLI. There was a three-fold increase in the unmet need for limiting among those women with increasing number of sons.

The Journal of Family Welfare

The unmet need for limiting reduces by 48 percent among women with at least one child loss, compared to women with no child loss. Presence of electronic media reduced the unmet need for limiting by 11 percent, compared to their counterpart. TABLE 6 Odds ratios of unmet need for contraception according to background characteristics from logistic regression model Category

Unmet Need Unmet Need for Spacing for Limiting



Exp(B)

Age

1.736 *

Exp(B) 1.90 *

Couple’s education

Category

Exp(B)

Exp(B)

Accessibility of Any Health Facility No @

1.000

1.000

Yes

1.017

0.937

Within 3 k.m. @

1.000

1.000

More than 3 k.m

1.003 0.993

Distance from Health Centre

Visit by F.P. Worker No @

1.000

1.000

Yes

1.093 **

1.056

States

Both Illiterate @

1.000

1.000

Bihar @

Only Husband literate

0.936 **

1.095 **

Uttaranchal

Only Wife literate

1.022

1.301 **

Rajasthan

Both literate

0.975

1.263 ***

Uttar Pradesh

2.886 *

Jharkhand

Son Ever Born

Unmet Need Unmet Need for Spacing for Limiting

1.147 *

Child loss No @

1.000

1.000

Yes

0.911 *

0.516 *

Hindu @

1.000

1.000

Muslim

1.235 *

0.773 ***

Others

0.714 *

Others @

Religion

1.000 1.000 0.845** 0.744* 0.634* 0.667* 0.968* 0.743* 1.114** 0.936

Orissa

0.499* 0.787*

Chhattisgarh

0.673* 0.600*

Madhya Pradesh

0.553* 0.731*

@ Reference category *** p < 0.01; ** p

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