Contraceptive method use among women in India: Does the family type matter?

Injectable Contraceptives as an Underutilized Option for Women's Reproductive Health: An Exploratory Qualitative Study

BACKGROUND

Injectable contraceptives (IC) provide a highly effective, reversible method of preventing conception, yet discontinuation rates are high. Health workers play a crucial role in the successful implementation of family welfare services. Adding up the basket of choices without knowing the community's needs can lead to poor utilization of services.

OBJECTIVES

To explore the facilitators and barriers to the utility of injectable contraceptives among reproductive women from the user's point of view and to understand solutions from the key informants.

METHODOLOGY

The study was conducted in the field practice areas among reproductive women attending a primary health center in Puducherry. It was an exploratory qualitative study in which in-depth interviews were conducted among 19 IC users using an interview guide. This was followed by a key informant interview with seven service providers, including doctors, staff nurses, auxiliary nurse midwives, and Anganwadi workers, to explore the solutions for the identified barriers. Purposive, convenient sampling was adopted for the selection of study participants, and the sample size was chosen until the point of saturation. Two investigators trained in qualitative research have performed a manual content analysis of transcripts to ensure credibility. Descriptive codes were derived, and similar codes were merged into categories and themes.

RESULTS

The most common facilitators were awareness from service providers and dissatisfaction with previous methods. Fear of side effects, inadequate information, out-of-pocket expenditure, lack of family support, and sociocultural myths were the most common barriers. Key informants suggested counseling on side effects, incentive-based follow-up, universal health insurance, couple-based counseling, training of service providers, and a positive deviance approach.

CONCLUSION

Health workers are pivotal in the successful delivery of family welfare services. The acceptability of IC could be improved by addressing concerns about side effects and its effective management through various targeted interventions.

Examining the influence of Mother-in-law on family planning use in South Asia: insights from Bangladesh, India, Nepal, and Pakistan

BACKGROUND

Contraceptive use contributes to improved maternal and child health, education, empowerment of women, slow population growth, and economic development. The role of the family in influencing women's health and health-seeking behavior is undergoing significant changes, owing to higher education, media exposure, and numerous government initiatives, in addition to women's enhanced agency across South Asia. Against this backdrop, this study assesses the relationship between women's living arrangements and contraceptive methods used in selected south Asian countries (India, Pakistan, Nepal, and Bangladesh).

METHODS

Data of currently married women aged 15-49 from the recent round of Demographic and Health Survey (DHS) of four South Asian countries, i.e., Nepal (2016), Pakistan (2017-18), Bangladesh (2017-18), and India (2019-21) had been used. Bivariate and multinomial logistic regression was performed using Stata with a 5% significance level.

RESULTS

Living arrangement of women had a significant association with contraceptive use in South Asia. The Mother-in-law (MIL) influenced the contraceptive method used by the Daughter-in-law (DIL), albeit a country-specific method choice. Modern limiting methods were significantly higher among women living with MIL in India. The use of the modern spacing method was considerably high among women co-residing with husband and/or unmarried child(ren) and MIL in Nepal and India. In Bangladesh, women living with husband and other family member including MIL were more likely to use modern spacing methods.. Women co-residing with the MIL had a higher likelihood of using any traditional contraceptive method in India.

CONCLUSIONS

The study suggests family planning program to cover MIL for enhancing their understanding on the benefits of contraceptive use and modifying norms around fertility. Strengthening the interaction between the grassroots level health workers and the MIL, enhancing social network of DIL may help informed choice and enhance the use of modern spacing methods. Women's family planning demands met with modern contraception, and informed contraceptive choices, must also be achieved to reach the 2030 Agenda for Sustainable Development.

Predictors of contraceptive use among young married women in India: Does pregnancy history matter?

AIM

Contraceptive use and its correlates among young women continue to draw research attention due to its implication for fertility reduction, improved maternal and child health, and sexual and reproductive rights. This study explores the association between pregnancy history and contraceptive use among currently married young women (aged 15-24 years at childbirth) in India.

METHOD

Data from the National Family Health Survey (2019-2021) was analyzed through STATA with a significance level of 5%. The births in the last 5 years preceding the survey to the women aged 15-24 years at childbirth (n = 127 954) were considered for analysis. Multinomial logistic regression was used to check the unadjusted and adjusted effects of the pregnancy history on contraceptive use.

RESULTS

Young women with a history of mistimed pregnancy had significantly lower odds of using modern limiting methods of contraception (odds ratio [OR] = 0.90, confidence interval [CI] = 0.82-0.98), and those with a prior unwanted pregnancy were more likely to use modern limiting methods of contraception (OR = 1.75, CI = 1.57-1.95).

CONCLUSION

Pregnancy history influences young married women's current contraceptive use in India. Family planning programs may use the contacts with antenatal, delivery, and post-delivery care system as an opportunity to identify women with an unwanted pregnancy, especially those educationally and economically weaker, for targeted information and service delivery. Better counseling of potential young contraceptive acceptors will ensure informed decision-making and increased use of modern spacing methods.

Associations between Contraceptive Decision-Making and Marital Contraceptive Communication and use in Rural Maharashtra, India

Women's contraceptive decision-making control is crucial for reproductive autonomy, but research largely relies on the Demographic and Health Survey (DHS) measure which asks who is involved with decision-making. In India, this typically assesses joint decision-making or male engagement. Newer measures emphasize female agency. We examined three measures of contraceptive decision-making, the DHS and two agency-focused measures, to assess their associations with marital contraceptive communication and use in rural Maharashtra, India. We analyzed follow-up survey data from women participating in the CHARM2 study (n = 1088), collected in June-December 2020. The survey included the DHS (measure 1), Reproductive Decision-Making Agency (measure 2), and Contraceptive Final Decision-Maker measures (measure 3). Only Measure 1 was significantly associated with contraceptive communication (adjusted odds ratio [AOR]: 2.75, 95 percent confidence interval [CI]: 1.69-4.49) and use (AOR: 1.73, 95 percent CI: 1.14-2.63). However, each measure was associated with different types of contraceptive use: Measure 1 with condom (adjusted relative risk ratio [aRRR]: 1.99, 95 percent CI: 1.12-3.51) and intrauterine device (IUD) (aRRR: 4.76, 95 percent CI: 1.80-12.59), Measure 2 with IUD (aRRR: 1.64, 95 percent CI: 1.04-2.60), and Measure 3 with pill (aRRR: 2.00, 95 percent CI: 1.14-3.52). Among married women in Maharashtra, India, male engagement in decision-making may be a stronger predictor of contraceptive communication and use than women's agency, but agency may be predictive of types of contraceptives used.