Abstract
ObjectiveTo 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.MethodsUsing 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.ResultsThe 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.ConclusionIndian family planning policy should prioritize women-centered care, making reversible contraceptive methods widely available and promoted.
Highlights
Ensuring universal access to sexual and reproductive health and reproductive rights for all women is Target 5.6 of the Sustainable Development Goals, promoted by the United Nations and adopted by 193 countries
We evaluated the coverage of demand for family planning satisfied (DFPS) with modern methods in India and the share of each type of contraception being used
Other short-acting reversible contraceptive methods, such as diaphragm, spermicidal agents, and emergency contraception were reported by only 9 women (< 0.01%), they were not included in the table the share of contraceptive methods used by women with DFPS with a modern method, showing that most women using contraceptives in India rely on permanent contraception (76.1%, 95% CI 75.5–76.6), while 20.7% are using short-acting reversible contraception (SARC), and 3.2% long-acting reversible contraception (LARC) methods
Summary
Ensuring universal access to sexual and reproductive health and reproductive rights for all women is Target 5.6 of the Sustainable Development Goals, promoted by the United Nations and adopted by 193 countries. To address women’s need for family planning, the provision of a wide range of safe, effective and affordable contraceptive methods is essential [1]. A nationally representative study found that India’s demand for family planning satisfied (DFPS) with modern contraceptive methods was 70% in 2005, with heavy reliance on female sterilization rather than reversible contraceptive methods [3]. These findings already suggested the need for greater focus on improving access to reversible methods, especially for women who wish to delay or space pregnancies but are not ready to commit to ending their fertility
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