Trend and Future Perspective of Modern Contraceptive Prevalence, Unmet Need, and Demand Satisfied for Modern Methods for All 38 Districts of Bihar State in India: Application of Family Planning Estimation Tool at District Level

Abstract

Background: Estimating couples in need and demand of contraceptives for a country helps policy makers for better planning, budget allocation and implement a focused program to achieve the desired goals, especially at district level. In Bihar, the state with India’s highest population density and lowest socioeconomic standing. The family planning indicators have been estimated and projected at the national and state levels in most attempts, while estimation at the district level has rarely been attempted. Methods: We have used a statistical model that can generate estimates and projections of rates and trends of indicators related to access to reproductive health at the national and sub-national levels. Avenir Health has packaged this model in the form of a user-friendly web application, the Family Planning Estimation Tool (FPET), which can be operated by local stakeholders with little external support. We present here annual estimates and projections of rates and trends of the modern contraceptive prevalence rate, unmet need, and demand satisfied for modern family planning methods at state level and its 38 districts from 1991 to 2030 with application of FPET. Findings: There is a large amount of heterogeneity between the districts; only three districts have high modern contraceptive prevalence rate (mCPR > 54%) and high met demand with a modern contraception of more than 74 percent in 2021; whereas five districts have low mCPR of less than 40 percent in 2021. It is estimated that 11 districts out of 38 districts are likely to reach met demand with a modern method greater than 74 percent by 2030. Overall Bihar requires additional 3.6 million users of modern contraceptives from 2021 to reach 74 percent of demand satisfied with modern contraceptive methods by 2030. But the findings estimate that approximately 3 million additional MWRA will be using modern contraceptive methods during 2021 and 2030 in Bihar. Indeed, the estimates suggest that the increase in the mCPR needed to achieve 74 percent or more demand satisfied with modern methods by 2030 in Bihar, four districts, namely, Kisanganj, Katihar, Gopalganj and Saran should be focused and prioritized followed by another five districts, namely, Siwan, Arwal, Purba Champaran, Sitamarhi, and Sheohar as these districts will be at the bottom of the table with less than 70 percent of demand satisfied with modern methods by 2030. Conclusion: The identification of districts that are performing better or worse helps decentralized planning effectively. The analysis can be generalized to other states and districts as well as other types of population subgroups.