Abstract
ObjectiveMeasuring current use of contraception relies on self-reported responses from survey respondents. Reporting validity may be affected by women's interpretation of the question and may vary by background characteristics of women. The study aims to understand levels and patterns of underreporting of female sterilization in a population with high sterilization rates. Study designData came from the Performance Monitoring and Accountability 2020 survey conducted in Rajasthan, India, in early 2017. In addition to a conventional question to ascertain current contraceptive use, the survey included a probing question; women who did not report sterilization as a current method were asked if they were ever sterilized. Women were defined as sterilization users based on either question. Among sterilized women, we estimated the percent who reported sterilization as a current method. Multivariable logistic regression analysis was conducted to assess differential reporting across background characteristics. ResultsAmong women who were ever sterilized, 78% reported currently using any contraceptive method(s), and 77% reported sterilization as the current method. Women in the lowest household wealth quintile or in general caste were less likely to report sterilization as a current method. Time since sterilization was not associated with correct reporting of sterilization. ConclusionThis study demonstrates, in a population with high sterilization, that sterilization as a current contraceptive method would be substantially underestimated using conventional survey questions. It highlights the importance of context-specific questionnaire adaptation to measure and monitor contraceptive use and provides implications in measuring current use of contraception in populations with high rates of sterilization. ImplicationsThe paper examined reporting of sterilization as a current method among sterilized women. Only 77% of sterilized women reported sterilization as a current contraceptive method. In a population with high sterilization, inclusion of a probe question in surveys is recommended to understand reporting quality and accurately measure contraceptive prevalence rates.
Highlights
The contraceptive prevalence rate is a key indicator to understand and monitor reproductive health in a population
Among all women included in our analysis, 30.4% [95% confidence internal (CI): 28.0–32.8] were sterilized — i.e., reported sterilization as Unadjusted odds ratioa
About 30% of women of reproductive age were sterilized in Rajasthan, India, and only 77% of them reported sterilization as a current contraceptive method
Summary
The contraceptive prevalence rate is a key indicator to understand and monitor reproductive health in a population. Current use of contraception among women of reproductive age has generally been measured through population-based surveys. The estimates of contraceptive prevalence are based on the responses from a sample of eligible women interviewed by female surveyors. A commonly used question in developing countries is: “Are you or your partner currently doing something or using any method to delay or avoid getting pregnant?” [1,2]. The validity of such responses has been a concern but assessed relatively rarely. Caste Scheduled caste Scheduled tribe Other backward caste General caste Religion Hindu Muslim Other
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