Type of Article: Research Article

Relationship of Contraceptive Use with Children Ever Born and Womens Empowerment in

India: A regional Analysis

Shobhit Srivastava

International Institute for Population Sciences, Mumbai

E mail : shobhitsrivastava889@gmail.com

Abstract

Background: From the very implementation of Family planning in India in 1952 the demographic

and health profile in India has changed drastically. The current use of family planning methods among

currently married women aged 15-49 has increased from 42.8% in NFHS-I (1992-93) to 53.5% in

NFHS-IV (2015-16).

Methods: Data has been analyzed from NFHS-III (2005-06), Trend analysis, Bivariate analysis to

find the prevalence, and Logistic regression has been used to carry out the study and find the results.

Results: As per trend analysis of NFHS the knowledge is almost now universal in nature across India

but even with the universal knowledge the use has been decreased in all four regions i.e. north-east,

east, south and west region except in north region. women in North-east region are significantly less

likely to use contraceptive methods in comparison to women in North region (O. R=0.681, p.001)

and women in south region are significantly more likely to use contraceptive method in comparison to

North region (O. R=1.629, p.001). women with high empowerment level are significantly more

likely to use contraceptive method in comparison to women with low empowerment level (O.

R=1.681, p.001). If children ever born to women is 3-5 then it is significantly more likely to use

contraception in comparison to women having children ever born equals 0-2 (O. R=2.855, p.001).

Conclusion: There is a wide gap between knowledge and use of Contraception among currently

married women aged 15-49. Therefore, there is the need to assess the shortcomings. There is need to
fulfil the unmet needs of contraception and focus on the important determinants which effect use and

non-use of contraception among women in India.

Key words- contraception, married women, children ever born, empowerment and regions.

Introduction

From the very beginning of Family planning in India the demographic and Health profile of

India has changed radically. The current use of Family Planning methods among currently

married women aged 15-49 has increased from 42.8% in NFHS-1 (1992-93) to 53.5% in

NFHS-4 (2015-16). The TFR decreased from 3.4 in NFHS-1 to 2.2 in NFHS-4. The decadal

growth rate of India was 21.5% from 1991-2001 and 17.7% from 2001-2011. Moreover, there

exist large-scale variations and diversities in the demographic situation and socioeconomic

and cultural milieu between and within the states and regions of the country. The fertility

remains very high in most of the northern part of the country. The contraceptive usage among

these states is relatively lower than the southern and western states. There is also a high

differential in contraceptive usage among different socioeconomic groups across the country.

As we know growth of population can be checked by either enhancing mortality or promoting

outmigration to other areas or by lowering the fertility levels. The first option is unacceptable

and the second is infeasible. Thus the only option that remains with any civilized society is by

lowering the fertility levels. Fertility behavior, as we know, is influenced by various cultural

controls and to an increasing number of government interventions as well (U. Ram, 2009).

Berelson (1977) mentioned numerous ways in which the government interventions can

influence fertility levels. These includes access to contraceptive methods of population

control including sterilization and abortion, bringing in changes in the attitudes towards

perceived role of socio-economic determinants education and literacy (especially for girls),

status of women, income and income equity, reproductive and child health issues etc., making

propaganda to promote desired views, provide incentives and disincentives through monetary

incentives to individual families for sterilization to limit family size, child stipends, benefits,

maternity/paternity leaves etc. and bringing in socio-political pressures or imposing direct

sanctions to minimum age at marriage and to limit family size.

The present paper focuses on the use of Modern and traditional methods of contraception

among currently aged 15-49. Paper focuses on how various socio-economic determinants are

affecting the use of contraception among currently married women. The region wise trend

analysis is done to bring in view how the current use of contraption has changed from 1992-

93 to 2015-16. Differential in ever and current use of contraception among various age group

has been analyzed. Data analyzed bring in view that how with the increase in knowledge of

contraceptive the current use of contraceptive has been decreased.

Literature Review

In the study by (F. Ram, Shekhar, & Chowdhury, 2014) it was found that in DLHS (2007-08)

revealed that 6.7% currently married women were using traditional contraceptive methods in

India. More than half of the currently married women (56%) have ever used these methods.

In the study it was found that The northeastern region showed higher odds ratios (5 times) of

women using traditional contraceptive methods than the southern region. In a study by

(Kerketta, Kumar, & Kumar, 2015) it was found that Women from rural area are 32%

(OR=0.681**) less likely to use contraception than urban women. Womens age is positively

related with current use of contraceptives. The likelihood of using contraception is 46%

(OR=0.549) lower among Muslims compared to Hindus. Women below middle school are
30% (OR= 1.302***) and women with middle complete are 67% (OR =1.669***) more

likely to use the contraceptive methods than the illiterate women. Women belonging to low

SLI (Standard of Living) are 44% (OR= 0.569*) less likely and with high SLI are 60% (OR

=1.5999*) more likely to use contraception, than women belong to medium SLI. Women use

more contraception with increasing parity. Among all the predictors womens education

found to be the most important. In the study by(Ghike, Joshi, Bhalerao, & Kawthalkar, 2010)

shows that was are the main reasons for non-use of contraceptive in rural India. The main

reason was family pressure (59%), non-use because of myths (2.1%), non-use because

children are god gift (11.7%).In the study by (Pandey & Singh, 2015) Of all the considered

explanatory variables religion, caste, education, current age, age at marriage, media exposure

and zonal classifications were found to be significantly affecting the study behaviour. Place

of residence i.e. urban - rural locality came to be insignificant in multivariable logistic

regression. In a study by (Jayaraman, Mishra, & Arnold, 2012)general, desire for another

child decreased and contraceptive use increased as the number of children and number of

sons increased. These associations were more prominent in Nepal and India than in

Bangladesh. For example, compared with women who had three daughters and no sons, the

odds of contraceptive use among women with two sons and one daughter were 4.8

inNepal,3.5 in India and 2.0 in Bangladesh. Within India, the associations of parity and

number of sons with reproductive outcomes were generally stronger in northern states than in

South India or West Bengal. In a study by (Pradhan, Reddy, Mishra, & Nayak, 2013) female

sterilization acceptance had declined (-0.6 point per year), while male sterilization had

increased (0.3 points annually) during the last five years. In-between NFHS-1 (1992-93) to

NFHS-3 (2005-06), the CPR in India increased by 1.2 point annually, and currently 56% of

the women are using any contraception. However, modern spacing method use increased at

merely 0.4 point per year.

Rationale of the Study

The study was needed to be done because to derive the reason and information regarding the

reason how empowerment level, Children ever born, Region and other socio-economic

determinants actually effect the contraceptive use in Indian subcontinent. Also the trend of

current contraceptive use from NFHS I to NFHS IV is being compiled in this study and the

possible reasons for the decrease in current contraceptive use with the increase in knowledge

of contraceptive among currently married women is being explained.

Objective

1. To understand the trend of contraceptive knowledge and current contraceptive use in

India

2. To examine determinants of contraception use among women in India

3. To examine the association between contraceptive use with empowerment and child

ever born in India.

Data and Methodology.

Firstly, the data source for the analysis come from the 2005-06 National Family Health

Survey (NFHS-III) and for the analysis for trends of prevalence of Family Planning methods

data from NFHS-I (1992-93), NFHS-II (1998-99), NFHS-III (2005-06) and NFHS-IV (2015-

16) * was used. The NFHS provides information on the demographic characteristic of

individual respondents, contraceptive use (current use and ever use) and knowledge. The

NFHS is comparable to the Demographic and Health Surveys (DHS) conducted in the other

developing countries. Interviews were conducted with 124,385 women age 15-49 and 74,369

men age 15-54 from all 29 states in NFHS-III. For the analysis of current paper data of

currently married and never married was used. Frequency of current married women is 87925
and in never married is 36460 (Never married 30661, widowed 3921, divorced 504, not

living together 1374). The 2001 census served as the sampling frame for the NFHS. Logistic

regression
Box-1 is used to estimate the current use model 1 and model 2. Two models were

estimated for Definitions.

Operational dependent variable-- one with region, Empowerment level and Children ever

1.
born-- 'Currently
and married'
the second women are
which included all women who
variables. have been
Bivariate married
analysis wasand
doneareto not
knoweither
the
divorced, widowed or separated. Persons living in consensual unions or in visiting
current use of contraceptive methods among currently married and never married women.
partnerships are also included in the currently married category.
Trend analysis was done to know the prevalence of current contraceptive use among women
2. Never Married women are those who are married but gauna not performed, widowed,
aged 15-45 in NFHS-I,
divorced, NFHS-II,
and not living NFHS-III and NFHS-IV. Dependent variables: Age,
Together.

Education,
3. Place ofEver
Children residence, Religion,
Born to women inChild ever born,
a particular children
age group is thesurviving, children
mean number loss,
of children
born alive to women in that age group. The number of children ever born to a particular
Empowerment level, Wealth, Media exposure and Regions of India. Independent Variable:
woman is a measure of her lifetime fertility experience up to the moment at which the data
contraceptive method (No use, Traditional and Modern).
are collected

4. Children surviving is the number of living children.

5. Children dead is the difference between children ever born and children surviving.

6. Empowerment Level includes Final say on own health care; Final say on making large
household purchases; Final say on making household purchases for daily needs; Final say
on visits to family or relatives; Final say on deciding what to do with money husband earns.

7. Media Exposure includes Frequency of watching Television; Frequency of listing Radio

and Frequency of reading Newspaper.
8. Regions of India: -
North Region: Delhi (N=3892), Haryana (N=2790), Himachal Pradesh (N=3193),
Jammu and Kashmir (N=3281), Punjab (N=3681), Rajasthan (N=3892), Uttarakhand
(N=2953), Uttar Pradesh (N=12183), Madhya Pradesh (N=6427).
North. East Region: Arunachal Pradesh (N=1647), Assam (N=3840), Manipur
(N=4512), Meghalaya (N=2124), Mizoram (N=1791), Nagaland (N=3896), Sikkim
(N=2127), Tripura (N=1906).
East Region: Bihar (N==3818), Jharkhand (N=2983), Orissa (N=4540), West Bengal
(N=6794), Chhattisgarh (N=3810).
West Region: Goa (N=3464), Gujarat (N=3729), Maharashtra (N=9034).
South Region: Andhra Pradesh (N=7128), Karnataka (N=6008), Kerala (N=3566),
Tamil Nadu (N=5919).
Results

Knowledge of contraceptive (Fig.1) shows that the knowledge of contraceptive is increased

from NFHS-I to NFHS- III. Almost in all regions of India the knowledge of contraceptive is

above 98% in NFHS-III.

Practice of contraceptive (Table-1) shows that how the percentage of not using

contraceptive is decreasing in North region from 54.5% to 40.9% from NFHS-1 to NFHS-2.

In case of all other regions i.e. North East region, East region, South region and west India

the percentage of not using contraceptive has decreased from NFHS-I to NFHS-III but has

Increased in NFHS-IV. The next portion shows how the percentage of Traditional method of

contraception has increased from NFHS I to NFHS III but had decreased in NFHS-IV in

North, North east and East region. In case of south region, the use of traditional method has

been decreased from NFHS-I to NFHS-IV. In case of west region, the trend is very uneven. In

the last portion of the table it has been seen that the use of modern method of contraceptive

has been increasing in North, North-east and East region from NFHS-I to NFHS IV but in

case of South and west region the use of modern method has first been increased from NFHS-

I to NFHS-III but then been decreased in NFHS-IV.

Contraceptive prevalence rate by various Background characteristics in NFHS-III

(2005-06) (Table-2) In this table Contraceptive prevalence is being shown among currently

married women aged 15-49 having knowledge of contraceptive here we can see that the value

of Chi-square is coming significant for all background variables. In here we can see that Non-

use of contraception is higher is higher in rural area and use of modern method is lower in

rural area, women having no education are using less contraceptive methods than women

having higher education also use of modern contraceptive increases with increasing

education. Hindu are using more modern contraceptive method than any other religion. As

the at first birth increases the use of contraceptive method decreases. Use of contraception is

there as women have intercourse with her partner. As age at first marriage increases the use of

contraception increases. Women having children between 3-5 are having high contraceptive

prevalence rate in comparison to women having children between 0-2 and more than 6. In

case of increase in age the use of contraception increases with increase in age. As

empowerment level among women increase use of contraceptive increases. Also with the

increase in wealth the use of contraception increases. High media exposure leads to high use

of contraceptive and case of region south and west region are having highest contraceptive

use in comparison to other three regions.

Odds Ratio (Table-3) shows odds ratio for current use of contraception among currently

married women. Model 1 (reduced model) estimates the three major independent variables.

Model 2 (full effect model) estimates these three variables and a series of independent

variables most of which can be considered control variables in order to discern if the impacts

of the original three variables are sensitive to the inclusion of these variables.

In Model 1 women in North-east region are significantly less likely to use contraceptive

methods in comparison to women in North region (O. R=0.681, p.001) and women in south

region are significantly more likely to use contraceptive method in comparison to North
region (O. R=1.629, p.001). women with high empowerment level are significantly more

likely to use contraceptive method in comparison to women with low empowerment level (O.

R=1.681, p.001). If children ever born to women is 3-5 then it is significantly more likely to

use contraception in comparison to women having children ever born equals 0-2 (O.

R=2.855, p.001).

The full effect model (Model 2) shows that effect of region and empowerment level were

virtually unchanged but effect on children ever born is changed from more significantly in

model 1 to less significantly in model 2. Now we can analyze that If children ever born to

women is 3-5 then it is less significantly more likely to use contraception in comparison to

women having children ever born equals 0-2 (O. R=1.086, p0.05). The inclusion of other

variables mediated the effect of children ever born on the use of contraception.

Women having higher education is significantly more likely to use contraception in

comparison to women having no education (O. R=1.864, p.001). If partner is having

primary education then it is significantly more likely that women use contraception in

comparison to partner having no education (O. R=1.146, p.001). Rural women are

significantly less likely to use contraception in comparison to urban women (O. R=0.927,

p.001). women having 4 or more surviving children are significantly more likely to use

contraception in comparison to women having no surviving children (O. R=41.848, p.001).

There is insignificant relationship between children loss and current use of contraception.

Women with high wealth is significantly more likely to use contraception in comparison to

women in low wealth status (O. R=1.916, p.001). women having media exposure is

significantly more likely to use contraception in comparison to women having no media

exposure (O. R=1.546, p.001).

Discussion
Though fertility rates have come down but still the fertility rates are higher in comparison to

the developed nations. In India, knowledge of contraceptive is universal but there exists a

wide gap between knowledge and acceptance. The non-use of contraception has increased in

all regions accept north region in the country. The possible reasons for this decline is still a

question but to find the possible reason micro level study has to be done. While in this regard

study in Rajasthan by (P, Tiwari, & Singh, 2015) found the possible reasons for non-use of

contraceptive and modern contraceptive methods. The use of traditional method of

contraception has declined in each region from NFHS III to NFHS IV. The use of modern

contraception method has increased in North region and we can see a slight increase in North

east and East region but had significantly declined in south and west region of the country.

Bi-variate analysis describe that contraceptive prevalence rate varies according to the

different socio-economic background characteristics of the women. The place of residence

has immense impact on utilization of family planning methods especially among women in

India. Current use of contraceptive methods among married women is higher in urban areas

(57.2%) as compared to rural areas (51.7%) (NFHS-IV). It is evident from the student that

education plays very important role in use of contraception. Hindu are more prevalent to use

contraception than any other religion. Age at first birth also plays very important role in use

of contraception. Around 50% women use contraception at their first intercourse, because

here education plays a big role woman in present era dont need children just after getting

married therefore this result shows perfect evidence of it. It is evident from the study that

with the increasing age at marriage women opt for contraception. (Arokiasamy, 2002) stated

that gender preferences (especially son preference) is the main factor in use and non-use of

contraceptive among women in India and as per my study the contraceptive use is highest

among women having children ever born between 3-5 and comparatively low in women

having children ever born 6 and above this indicates the son preference in my study. In this
study we also found that with increasing age the use of contraception increases in married

women. Empowerment level and level of wealth also plays a major role in use of contraption

among women with the increase in both empowerment level and wealth there is increase in

level of use of contraception among women.(Asiimwe et al., 2014) found that women

listening to radio are more prevalent to contraceptive than other women and in my study also

Women having media exposure i.e. (includes Frequency of watching Television; or

Frequency of listing Radio or Frequency of reading Newspaper) are more prevalent to use

contraception than women who are not exposed to any media exposure. When we see

prevalence of use of contraception region wise we found that the least prevalence of use of

contraception is in North-East India where as the most prevalent region in terms of

contraceptive use is south and west region.

From the results of logistic regression from the reduced model 1 its evident that women in

north east are 32% significantly less likely to use contraception in comparison to north region

where as in south region women are 63% significantly more likely to use contraception in

comparison to women in north region. women with high empowerment level are 68% more

likely to use contraception in comparison to women in low empowerment level. Women

having children ever born 3-5 are 3 times more likely to use contraception in comparison to

women having children ever born 0-2.

In full effect model 2 Women having higher education is 1.9 times significantly more likely

to use contraception in comparison to women having no education. Women having children

surviving 4 and more are 42 times significantly more likely to use contraception in

comparison to women having children surviving equals 0. Women with high wealth level are

1.9 times significantly more likely to use contraception in comparison to women with lower

wealth level. And women with positive media exposure are 1.55 times significantly more

likely to use contraception in comparison to women having no media exposure.

Conclusion

The concern is more that with almost universal knowledge of contraceptive method among

currently married women aged 15-45 the use of contraceptive methods has declined, the

possible reasons are unknown and micro level study is very important in this regard. The

possible reasons may be increasing unmet needs, lack in affordability and accessibility etc.

Women education, children ever born, children surviving and empowerment level are most

important determinants for the use of contraception among currently married women.

Limitations

Firstly, the data is secondary in nature so we need to qualitative research to know the exact

reason for the outcome of results. Micro level study is needed in this field for much more

refined study. Union territories are added in NFHS IV data and other round of NFHS do not

include union territories. Division of regions must be more refined.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: Not required

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 Table 1: Trends of contraceptive use and non-use by currently married women aged 15-49 in all four
round of NHFS.
NFHS 1 (1992- NFHS 2 (1998- NFHS 3 (2005- NFHS 4 (2015-
93) 99) 06) 16)
Not using
North region 54.5 60 49.4 40.9
North-east region 65 57.2 45.8 61.9
East region 61.1 55.8 49.1 51.8
South region 47.7 42.1 34.8 42.2
West region 49.8 39.8 33.4 58.3

Traditional use
North region 4.4 5.2 8.8 7.6
North-east region 10.3 14.2 25 7.6
East region 7.8 9.4 10.7 7.4
South region 3.9 2.3 2.2 0.8
West region 4.5 2.7 4.9 1.68

Modern use
North region 41.1 34.7 41.8 51.2
North-east region 24.7 28.6 29.2 29.9
East region 31.1 34.8 40.2 40.5
South region 48.4 55.7 63 57
West region 45.8 57.5 61.7 39.8
N=84678 N=83649 N=87925 N= 625000*

*NFHS 4 all Women, sample of currently married women ye not available.

 Table 2: Contraceptive prevalence rate among currently married women aged (15-49) having
knowledge of contraception in India, NFHS (2005-06) (N=77671)

Currently married

Background None Traditional Modern N=Frequency Value of Chi-

characteristics square

Place of Residence
Urban 35.9 8.6 55.4 35927 2=801.844 P.001
Rural 47.3 8.6 44 41744
Education
No 49 7.4 43.6 27577 2=648.017 P.001
Primary 39.5 7.8 52.7 11900
Secondary 40.1 9.8 50 30510
Higher 35.6 12.5 51.9 7680
Religion
Hindu 42.3 8.5 49.3 57844 2=495.260 P.001
other 49.2 9.3 41.4 19827
Age at first birth (in
years)
18 and Less 37.3 7.9 54.8 27066 2=602.821 P.001
19-24 38.7 9.5 51.7 34567
25 and More 40.6 13.4 46.1 8593
Age at first intercourse
(in years)
Not had intercourse 100 0 0 24 2=128.909 P.001
7-44 42.1 8.7 47.2 11439
at first Union 41.7 4.2 47.1 66208
Age at first marriage (in
years)
15 and Less 43.5 7.4 49.1 19763 2=401.614 P.001
16-20 44.2 8.7 47.2 40129
21 and More 41.7 11.2 47.1 17779
Children ever born
0-2 53.7 9.1 37.2 41414 2=4642.637
3-5. 29 7.3 63.7 29823 P.001
6+ 48.9 11.3 39.8 6434
Current age (in years)
15-24 71.4 7.6 21 16883 2=7444.367
25-34 37.2 9.3 53.5 30630 P.001
35-49 30.9 8.6 60.5 30158
Empowerment Levels
Low 51.6 8.9 39.5 25220 2=1050.652
Medium 39.8 8.4 51.9 25442 P.001
High 37.3 8.6 54.1 27009
Wealth
Low 52.5 8.6 38.9 25512 2=1931.036
Middle 39.5 7.7 52.8 25447 P.001
High 32.6 9.8 57.6 26712
Media
No 56.1 7.9 36 12872 2=1120.699
Yes 39.7 8.9 51.4 64799 P.001
Region
North 48.8 9.1 42.1 28385 2=3186.658
North east 43.9 26.3 29.8 12016 P.001
East 47.8 11.2 41 14899
South 35.2 2.9 61.9 12244
West 33.1 5.2 61.7 10137
 Table 3: Odds ratio associated with the determinants of current contraceptive use for currently married
women. (N=87925)
Model 1 Model 2
95% 95%
Background Significant level Significant level
characteristics
Odds Ratio Lower Upper Odds Ratio Low Upper
er
Region
North 1 1
North East 0.681*** 0.653 0.711 0.833*** 0.79 0.875
3
East 0.962* 0.924 1.001 1.190*** 1.13 1.244
7
South 1.629*** 1.563 1.697 1.578*** 1.50 1.654
6
West 1.347*** 1.286 1.411 1.286*** 1.22 1.355
1
Empowerment
levels
Low 1 1
Medium 1.460*** 1.410 1.511 1.145*** 1.10 1.190
2
High 1.681*** 1.624 1.741 1.154*** 1.10 1.200
9
Children ever
born
0-2 1 1
3-5 2.855*** 2.769 2.943 1.086* 0.99 1.188
2
6+ 1.244*** 1.184 1.308 0.612*** 0.54 0.692
1
Education
No Education 1
Primary - - - 1.213*** 1.15 1.274
4
Secondary - - - 1.258*** 1.19 1.319
9
Higher - - - 1.864*** 1.71 2.025
6
Partner
Education
No Education 1
Primary - - - 1.146*** 1.08 1.206
8
Secondary - - - 0.972 0.92 1.018
9
Higher - - - 1.037 0.96 1.112
7
Place of
residence
Urban 1
Rural - - - 0.927*** 0.89 0.962
3
Religion
Hindu 1
Other - - - 0.558*** 0.53 0.579
8
Children
surviving
0 1
1 - - - 7.200*** 6.61 7.832
9
2 - - - 29.296*** 26.9 31.839
56
3 - - - 43.080*** 38.1 48.589
96
4 and More - - - 41.848*** 36.9 47.344
90
Children loss
0 1
1 - - - 0.991 0.94 1.044
0
2 and More - - - 0.953 0.88 1.032
0
wealth
Low - - - 1
Medium - - - 1.526*** 1.46 1.592
2
High - - 1.916*** 1.81 2.026
2
Media
No 1
yes - - - 1.546*** 1.48 1.616
0
Note: ***p.001, ** p.01, * p.05, where p is significant level.