Abstract
BackgroundDespite six decades of official family planning programme, the use of modern contraceptive method remained low in India. The discontinuation of modern spacing method (DMSM) has also increased from 42.3% in 2005−06 to 43.6% during 2015–16. Discontinuation rate is higher for Injectable (51%), followed by condom (47%), pill (42%) and lowest in IUD (26%).MethodsData from NFHS-4 (2015–16) comprising of 601,509 households, 699,686 women and a sample of 119,548 episode of modern spacing method was used for the analysis. Multiple decrement life table has used to estimate 12-month discontinuation rate of modern spacing methods (DMSM). Moran’s I statistics, Bivariate LISA cluster map has used to understand the spatial correlates and clustering the DMSM. OLS model and impact analysis has used to assess the significant associated covariates with discontinuation.ResultThe 12-month DMSM in India is 43.5%; largely due to desire for becoming pregnant and method failure. The high discontinuation rate was observed in most of the southern (62%) and central (46%) regions of India. DMSM has significantly and spatially associated with neighbouring districts of India (Moran’s I = 0.47, p-value = 0.00). The prevalence of modern spacing method is negatively associated with discontinuation in the neighbouring districts of India. The unmet need (β = 0.84, 95% CI 0.55–1.14), desire of children (β = 0.26, 95% CI − 0.05–0.57) and female sterilization (β = 0.54, 95% CI 0.14–0.95) were three main contributing factor to DMSM.ConclusionDistricts of high DMSM need programmatic intervention. More attention for counselling to client, health worker outreach to user and better quality care services will stimulate non-user of contraception.
Highlights
Since International conference of population and development (ICPD), Cairo, 1994, access to increase the use of contraception and maternal care has been integrated in global and national development agenda
We examine the spatial heterogeneity of discontinuation of modern spacing method in 640 district of India
Using secondary data of National family health survey (NFHS)-4 (2015–16), we calculated 12-month discontinuation rate of any method and any modern spacing method by reason of discontinuation, we presented discontinuation pattern by regions of India
Summary
Since International conference of population and development (ICPD), Cairo, 1994, access to increase the use of contraception and maternal care has been integrated in global and national development agenda. Though countries are converging on use of contraception and maternal care services, but they differ widely with respect to use of methods, access to contraception, quality of care, unmet need and method choice [2, 3]. In almost every country contraceptive failure within a year of method use, higher among younger women [2, 8,9,10,11,12]. The low use of modern spacing method and the likelihood of discontinuation is higher among women with high unmet need for the family planning. Contraceptive discontinuation can be reduced by expanding choice of methods, information to clients, technical competence, interpersonal relations, follow-up and continuity mechanisms, and the appropriate constellation of services, which are component of overall quality of care [9]. Discontinuation rate is higher for Injectable (51%), followed by condom (47%), pill (42%) and lowest in IUD (26%)
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