Population Council Research that makes a difference

2011 International Conference on Family Planning
29 November–2 December 2011

Abstract

"Postpartum contraceptive use and unmet need for contraception among adolescent and young women: Issues and challenges in India"
Avishek Hazra and M.E. Khan

Background
In the developing world 17 percent of all married women prefer to avoid a pregnancy but are not using any family planning (FP) method. In each country, understanding the size of unmet need and characteristics of women with unmet need can help planners strengthen programs. Survey data on unmet need can provide overall direction by helping to identify the hindrances in society and weaknesses in services that need to be overcome. Literature shows that closely spaced pregnancies pose health risks to both mothers and newborns. The risk is more among the youth mothers, who contribute more than half of India’s total fertility. FP could prevent up to one-third of all maternal deaths by allowing women to delay motherhood, space births, avoid unintended pregnancies and unsafe abortions, and stop childbearing when they attain their desired family size (Collumbien et al., 2004).

Main Question
This paper examines: (a) trend of postpartum contraceptive use and unmet need for contraception among youth women at national and regional level over the past two decades, (b) inequality in postpartum contraceptive use by different caste and class, and (c) individual, household and community level barriers on postpartum contraceptive use.

Methodology
The paper utilizes data from three rounds of National Family Health Surveys (NFHS) in India conducted during 1992–93 (NFHS-1), 1998–99 (NFHS-2) and 2005–06 (NFHS-3); and third round of District Level Household Survey (DLHS-3) conducted in 2007–08. The present study focuses on adolescent and youth women (aged 15–24 years). Time series analysis has been done to examine the trend in postpartum contraception and box plots have been used for a comprehensive understanding of variation in contraceptive use and unmet need in the Indian states. For the second objective, Gini concentration index and Lorenz curve have been used. In the third objective, logistic regression and multilevel analysis depict the effect of different level factors that facilitate or act as barriers to use of contraceptive. The analysis has been done in SPSS and ML-Win software.

Results
28 percent of married women aged 15–24 used any method of contraception in 2005–06. Contraceptive use increased by only 12 percent point in the last 13 years. Female sterilization was the most preferred method among youth age 20–24. By contrast, among married adolescents, most preferred method was rhythm. One-fourth of the youth had an unmet need for FP. A marginal decline in unmet need for FP is noticed since 1998–99. Unmet need was particularly high in some states that have both high fertility and low contraceptive use among youth; this suggests that many youth may be having more births than they want because their specific needs are not being met by FP. Unintended pregnancy has remained high in India. The gap between total fertility rate (TFR) and wanted fertility rate also demonstrates that a substantial portion of births were unwanted. In 2005–06, at the national level TFR was 2.7, while the wanted fertility rate was 1.9. That means if unwanted births could be prevented, fertility rate would have been below 2. Even in the northern states like Uttar Pradesh and Bihar, where TFR is about 4, the wanted fertility rate is only about 2. Although the gap in percentage of contraceptive use between non-literate and those educated up to secondary level, and Scheduled Castes and other castes has remained high, disparities has been reduced by 3–5 percentage points. The Lorenz curve indicates that FP use vary significantly by wealth quintiles. Variables like wealth index, education and BCC index have significant positive impact on contraceptive use. Women with secondary or higher education (OR=2.69, p<0.01), belonging to richest households (OR=2.41, p<0.01) and who received high score in BCC index (OR=1.84, p<0.01) were more likely to use contraception compared to their respective reference groups. The results from multilevel analysis are in progress and yet to be added.

Knowledge contribution
Assessing the level and trend in FP use and unmet need, and identifying the key barriers and facilitating factors at different level, this paper discusses about possible BCC strategy and critical challenges ahead. The results on BCC index indicates that women need to be counseled repetitively on the full range of available contraceptive methods so that they can choose the method that best matches their individual circumstances and can change methods when they need. Larger desired family size and programmatic bias for sterilization together contributing to unmet need and unintended pregnancy significantly. Until family size is reduced, spacing could help in increasing length of generation. Addressing adolescents and youth FP needs is a missing link and needs strengthening. However there are some critical challenges:

1. What programmatic interventions and BCC strategy could help in reducing unmet need, increase postpartum contraception and spacing between births?

2. How to address adolescents and youth information and contraceptive service needs?

3. How to reach poor and disadvantaged groups with FP services?

 

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