Validation of a family planning self-efficacy measure with married women in Bihar, India: Findings from the Bihar Integrated Family Planning Survey

Abstract

ObjectivesAdapting and testing a novel measure of family planning self-efficacy (FPSE) capturing reproductive agency and examining its association with fertility intention and contraceptive use in India. Study DesignData were analyzed from 13,901 non-sterilized, currently married women of reproductive age (15-49 years) in the Bihar Integrated Family Planning Survey (BIFS) 2021. We adapted an FP Self Efficacy measure previously developed in Guatemala comprising women’s agency to overcome barriers to accessing, discussing and using contraception, regardless of family pressure and social judgment. We used factor analyses to assess construct metrics including reliability and validity. Regression analyses were used to examine the associations of FPSE with key family planning outcomes, adjusted for age, education, caste/tribe status, religion, parity, age at marriage and family type. ResultsThe BIFS women’s sample was relatively young (35% below 25 years of age), with 43% reporting no education and over half (52%) married before 18 years of age. The 9-item FPSE scale demonstrated high reliability (Cronbach’s α=0.82) with two factors – self-efficacy to access and discuss contraception versus self-efficacy to use contraception in the face of resistance. Higher FPSE was associated with spousal communication [AOR: 2.35 (95% CI: 2.18, 2.54), traditional [AOR: 1.24 (95% CI: 1.12,1.36)] and reversible modern contraception [AOR: 1.58 (95% CI: 1.43,1.75)], and fertility intention [AOR: 1.13 (95% CI: 1.01,1.25)]. ConclusionFP Self Efficacy was found to be a reliable and valid measure associated with spousal communication, reversible contraception use and fertility intention. ImplicationsInnovations in measurement to understand reproductive agency, such as family planning self efficacy, place women’s choice as important goals of FP programming. Placing women’s choice and agency as goals of FP programs can help in meeting community needs and the demand for contraceptive use.