- Email: [email protected]
Decline in contraceptive use in India: A call for action
Accepted Manuscript Short communication Decline in Contraceptive Use in India: A Call for Action Rajesh Kumar Rai PII: DOI: Reference:
S1877-5756(17)30182-9 http://dx.doi.org/10.1016/j.srhc.2017.08.006 SRHC 320
To appear in:
Sexual & Reproductive Healthcare
Received Date: Revised Date: Accepted Date:
3 July 2017 21 August 2017 26 August 2017
Please cite this article as: R. Kumar Rai, Decline in Contraceptive Use in India: A Call for Action, Sexual & Reproductive Healthcare (2017), doi: http://dx.doi.org/10.1016/j.srhc.2017.08.006
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Short communication Decline in Contraceptive Use in India: A Call for Action
Author Rajesh Kumar Rai 1*
Competing interests None to disclose
Funding No specific funding received to perform this study.
Abbreviated running title Contraceptive Use in India
* Corresponding author 1
Rajesh Kumar RAI, MA MPhil MPH
Senior Research Scientist Society for Health and Demographic Surveillance Suri, Birbhum 731101, West Bengal, India Tel. (Office): +91-3462 - 250371 Email: [email protected]
Decline in Contraceptive Use in India: A Call for Action
Abstract Select estimates of contraceptive use in the 2015-16 National Family Health Survey (NFHS is equivalent to the Demographic and Health Survey in India) have come under the scrutiny of researchers and policy makers globally. Using four waves (1992-93, 1998-99, 2005-06, and 2015-16) of published NFHS reports, this article aims to highlight the change in Contraceptive Prevalence Rate (CPR) and initiate a discussion to help investigate the reasons for the recent decline of CPR.
Keywords: Family Planning, Women, Contraception, Fertility, Demographic and Health Survey
1
Background Select estimates of contraceptive use in the 2015-16 National Family Health Survey (NFHS is equivalent to the Demographic and Health Survey in India) [1] have come under the scrutiny of researchers and policy makers. This time, the story line was to speculate the reasons for the declining trend of the Contraceptive Prevalence Rate (CPR) between 2005-06 and 2015-16. NFHS has been a major policy guiding national survey report for the Indian government [2]; Earlier reports of NFHS show an increasing trend of CPR during 1992-2006; however, there has been a decline from 56.3 percent in 2005-06 to 53.5 percent in 2015-16 for any method, and a downward trend for the modern method of contraception as well [1]. These statistics are alarming.
Family planning, or the practice of using contraceptives, is not only deemed a function of fertility preferences – birth spacing and limiting, but also plays a crucial role in addressing all eight Millennium Development Goals [3]. Its continued importance in achieving some targets of the Sustainable Development Goals cannot be denied [4]. As described in the United Nations Declaration of Human Rights, the use of contraceptives helps women and couples have the number of children they want, when they want them. In addition, the use of contraception leads to reduction in pregnancy related risk, teenage pregnancies and child mortality. Although CPR had decreased during 2005-2016, a decline in total fertility rate (TFR) from 2.7 in 2005-06 to 2.2 in 2015-16 was registered [1]. India is close to meeting the target of below replacement level fertility rate (TFR of 2.1 lifetime birth per woman), but it still bears an unacceptably high burden
2
of unwanted fertility, which could be avoided through effective use of contraception. Inconsistencies in the relationship between CPR and TFR have been experienced in some south Asian countries such as Bangladesh [5], but to establish concordance between declining CPR and falling TFR in India requires deeper investigation. Bongaarts’s framework about determinants of fertility regards contraceptive use as a deliberate marital fertility control factor, and the absence of contraception (and induced abortion) implies the existence of natural fertility [6]. Using four waves (1992-93, 1998-99, 2005-06, and 2015-16) of published NFHS reports, this article aims to highlight the change in CPR and initiate a discussion to help investigate the reasons for its recent decline.
Trends in Contraceptive Use Before comparing estimates of CPR from NFHS reports, it is important to understand the way in which questions are asked and estimates computed. In NFHS, currently married women (including women who were not pregnant or were unsure about pregnancy during the survey) were asked by an interviewer, “Are you currently doing something or using any method to delay your pregnancy or avoid getting pregnant?”, and if the answer was affirmative, the follow-up question was, “Which method are you using?”[7]. The guideline reads that interviewers might have to “probe to determine that the method is being used currently” [8]. Although, the guideline emphasizes the word, ‘currently’, it does not provide a reference period for it, which might lead to a biased response. For example, if a couple’s recent sexual intercourse was (say) 90 days preceding the survey date and they used coitus-related methods such as condoms, vaginal methods and withdrawal, it was unclear whether the use of contraceptives could be termed
3
‘current use’. It is possible that NFHS survey participants responded to this question arbitrarily and a significant proportion of respondents had misclassified their response as negative.
India was the first country to introduce its National Family Planning Programme in 1952, but it struggled to upscale its implementation. Till date, there has been intense discourse, (primarily on paper), on strengthening India’s family planning programme, which includes creating a domestic policy and being signatory to an international commitment; this has helped to some extent. In a recent move, the 2017 National Health Policy[9] aims to “meet (the) need of family planning above 90 percent at national and sub-national levels by 2025”, against the current unmet need of nearly 13 percent. Between 1992-93 and 2015-16, the CPR for any method and modern method, increased 13 percent and 11.5 percent, respectively (Table 1) varying by state, where Kerala reported the highest in CPR for any method in 1992-93, and West Bengal reported the highest in 2015-16. But the decline in CPR for both methods between 2005-06 and 2015-16 gives cause to ponder. When estimates of CPR were compared for 28 states, 18 states registered a decline in CPR for both/any method and modern methods of contraception (Figure 1). It was surprising that some developed states like Kerala and Delhi performed worse than Uttar Pradesh did (Uttar Pradesh is considered one of the high focus group states in need of special attention) in terms of direction of change in CPR. During the same period, prevalence of female sterilization, male sterilization and use of intrauterine device (IUD)/postpartum IUD (PPIUD) decreased, whereas an increasing trend was observed for the use of condoms and pills (Figure 2).
Until the NFHS dataset is available for analysis, it is too early to pinpoint the exact reasons for the overall decline in CPR. What about the performance of the public healthcare service sector
4
that caters to a big chunk of population, especially in rural India? During 2005-06, over 70 percent of all contraceptives were obtained from the public medical sector [10] and this figure is expected to rise, but it is discouraging to note that only about 18 percent of total female non-users (46.5 percent) were engaged in any discussion about family planning with health workers [1]. This suggests that very few community health workers (CHWs) follow the guidelines for distributing contraceptives and conducting counseling for contraceptive uptake. Decline in both male and female sterilization probably contributes to the highest share in decline in CPR. As couples are opting for fewer children, perhaps CHWs or counselors are not encouraging clients to opt for permanent sterilization. The government’s guideline indicates that in order to conduct a male or female sterilization, woman/man/couple “should have at least one child, whose age is above one year, unless the sterilization is medically indicated” [11, 12]. But what if there is sex preference or preference in the composition of children? An informed choice will not help increase the compliance for permanent sterilization, as a man/woman/couple may want to keep the option open to beget a child of their desired sex in the future. Besides, people may not opt for a permanent method because they want to have the option of having children as a measure of fertility risk management, in case of death of their child/children. This reasoning perhaps prompts people to opt out of permanent sterilization, and in the face of falling fertility, it accounts for the decline in overall CPR in India; again, this leads to prolonged fecundity. On the other hand, a reduction in the use of IUD/PPIUD could be attributed to the extent of access to medical facility for IUD/PPIUD insertion, given that the counseling for it is conducted properly. The insertion and removal of IUD/PPIUD requires a skilled provider with proper counseling of clients [13], but all public facilities are not equipped with trained medical officers and nurses to perform the procedure. In a four-tier facility in India (Sub Centre, Primary Healthcare Centre,
5
Community Healthcare Centre, and District Hospital), it is doubtful if skilled personnel are available at all levels of public health care institutions, and if the counseling is done properly.
Concluding Remarks The declining trend of CPR during 2005-16 demands urgent attention by researchers and policy makers. Although the total fertility rate has reduced to 2.2, the reduction in CPR may lead to inflated unwanted fertility in the future. People seem to want to prolong their fecundity as a measure to attain their desired fertility and to manage their future risk of fertility. Thus, with increasing risk of higher fertility, India might witness poor maternal and child health outcome and this adverse consequence on health would lead to financial burden. As an immediate measure, the Government of India should undertake an initiative to assess the extent of access to contraception. As health is a state subject, all the states in India should focus on up-scaling modern spacing methods for greater user satisfaction.
References [1] International Institute for Population Sciences. National Family Health Survey 2015-16: India Fact Sheet. International Institute for Population Sciences: Mumbai; 2017. [2] Dandona R, Pandey A, Dandona L. A review of national health surveys in India. Bull World Health Organ 2016; 94(4): 286–296A. [3] Cates W Jr, Abdool Karim Q, El-Sadr W, Haffner DW, Kalema-Zikusoka G, Rogo K, Petruney T, Averill EM. Family planning and the Millennium Development Goals. Science 2010; 329 (5999): 1603.
6
[4] Starbird E, Norton M, Marcus R. Investing in family planning: key to achieving the Sustainable Development Goals. Glob Health Sci Pract 2016; 4(2): 191-210. [5] Saha UR, Bairagi R. Inconsistencies in the relationship between contraceptive use and fertility in Bangladesh. Int Fam Plan Perspect 2007; 33(1): 31-37. [6] Bongaarts J. A framework for analyzing the proximate determinants of fertility. Popul Dev Rev 1978; 4(1): 105-132. [7] International Institute for Population Sciences. National Family Health Survey 2015-16: Woman’s Questionnaire. International Institute for Population Sciences: Mumbai; 2014. [8] International Institute for Population Sciences. National Family Health Survey 2015-16: Interviewer’s Manual. International Institute for Population Sciences: Mumbai; 2014. [9] Ministry of Health and Family Welfare. National Health Policy. Ministry of Health and Family Welfare, Government of India: New Delhi; 2017. [10]
International Institute for Population Sciences. National Family Health Survey
2005-06: National Report. International Institute for Population Sciences: Mumbai; 2007. [11]
Ministry of Health and Family Welfare. Reference Manual for Male Sterilization.
Ministry of Health and Family Welfare, Government of India: New Delhi; 2013. [12]
Ministry of Health and Family Welfare. Reference Manual for Female
Sterilization. Ministry of Health and Family Welfare, Government of India: New Delhi; 2014. [13]
Ministry of Health and Family Welfare. IUCD Reference Manual for Medical
Officers and Nursing Personnel. Ministry of Health and Family Welfare, Government of India: New Delhi; 2013.
7
Table 1 Current Use of Contraceptives in India, National Family Health Survey (NFHS), 1992-2016
India Delhi Haryana Himachal Pradesh Jammu region of Jammu & Kashmir Jammu & Kashmir Punjab Rajasthan Uttarakhand Chhattisgarh Madhya Pradesh (including Chhattisgarh) Madhya Pradesh (excluding Chhattisgarh) Uttar Pradesh (including Uttarakhand) Uttar Pradesh (excluding Uttarakhand) Bihar (including Jharkhand) Bihar (excluding Jharkhand) Jharkhand Odhisa West Bengal Arunachal Pradesh Assam Manipur Meghalaya Mizoram Nagaland Sikkim Tripura
NFHS 1992-93 Any Any Method Modern Method 40.6 36.3 60.3 54.6 49.7 44.3 58.4 54.4 49.4 39.7 na na 58.7 51.3 31.8 30.9 na na na na 36.5 35.5 na na 19.8 18.5 na na 23.1 21.6 na na na na 36.3 34.6 57.4 37.3 23.6 19.3 42.8 19.8 34.9 24.1 20.7 15.1 53.8 52.9 13.0 13.0 na na 56.1 28.6
NFHS 1998-99 Any Any Method Modern Method 48.2 42.8 63.8 56.3 62.4 53.2 67.7 60.8 na na 49.1 41.7 66.7 53.8 40.3 38.1 na na na na 44.3 42.6 na na 28.1 22.0 na na 28.1 22.4 na na na na 46.8 40.3 66.6 47.3 35.4 32.8 43.3 26.6 38.7 25.9 20.2 15.5 57.7 57.1 30.3 24.2 na na 53.8 41.4 8
NFHS 2005-06 Any Any Method Modern Method 56.3 48.5 66.9 56.5 63.4 58.3 72.6 71.0 na na 52.6 44.9 63.3 56.1 47.2 44.4 59.3 55.5 53.2 49.1 na na 55.9 52.8 na na 43.6 29.3 na na 34.1 28.9 35.7 31.1 50.7 44.7 71.2 49.9 43.2 37.3 56.5 27.0 48.7 23.6 24.3 18.5 59.9 59.6 29.7 22.5 57.6 48.7 65.7 44.9
NFHS 2015-16 Any Any Method Modern Method 53.5 47.8 53.0 47.3 63.7 59.4 57.0 52.1 na na 57.3 46.1 75.8 66.3 59.7 53.5 53.4 49.3 57.7 54.5 na na 51.4 49.6 na na 45.5 31.7 na na 24.1 23.3 40.4 37.5 57.3 45.4 70.9 57.0 31.7 26.6 52.4 37.0 23.6 12.7 24.3 21.9 35.3 35.3 26.7 21.4 46.7 45.9 64.1 42.8
Goa Gujarat Maharashtra Andhra Pradesh (including Telangana) Andhra Pradesh (excluding Telangana) Telangana Karnataka Kerala Tamil Nadu
47.8 49.3 53.7 47.0 na na 49.1 63.3 49.8
37.9 46.9 52.2 46.5 na na 47.3 54.4 45.2
47.5 59.0 60.9 59.6 na na 58.3 63.7 52.1
na: not applicable / available.
9
35.9 53.3 59.9 58.9 na na 56.5 56.1 50.3
48.2 66.6 66.9 67.6 na na 63.6 68.6 61.4
37.2 56.5 64.9 67.0 na na 62.5 57.9 60.0
26.3 46.9 64.8 na 69.5 57.2 51.8 53.1 53.2
24.8 43.1 62.6 na 69.4 56.9 51.3 50.3 52.6
Figure 1 Percentage Point Change in the Use of Any Method and Any Modern Method, National Family Health Survey, 2005-16
Figure 2 Change in Select Modern Contraceptive Use in India, National Family Health Survey (NFHS), 1992-2016 10
Decline in Contraceptive Use in India: A Call for Action
Highlight
1. Between 1992-93 and 2015-16, the Contraceptive Prevalence Rate (CPR) for any method and modern method, increased 13 percent and 11.5 percent, respectively.
2. Some developed states like Kerala and Delhi performed worse than Uttar Pradesh in terms of direction of change in CPR.
3. The Government of India should undertake measures to assess the extent of access to contraception.
11
S1877-5756(17)30182-9 http://dx.doi.org/10.1016/j.srhc.2017.08.006 SRHC 320
To appear in:
Sexual & Reproductive Healthcare
Received Date: Revised Date: Accepted Date:
3 July 2017 21 August 2017 26 August 2017
Please cite this article as: R. Kumar Rai, Decline in Contraceptive Use in India: A Call for Action, Sexual & Reproductive Healthcare (2017), doi: http://dx.doi.org/10.1016/j.srhc.2017.08.006
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Short communication Decline in Contraceptive Use in India: A Call for Action
Author Rajesh Kumar Rai 1*
Competing interests None to disclose
Funding No specific funding received to perform this study.
Abbreviated running title Contraceptive Use in India
* Corresponding author 1
Rajesh Kumar RAI, MA MPhil MPH
Senior Research Scientist Society for Health and Demographic Surveillance Suri, Birbhum 731101, West Bengal, India Tel. (Office): +91-3462 - 250371 Email: [email protected]
Decline in Contraceptive Use in India: A Call for Action
Abstract Select estimates of contraceptive use in the 2015-16 National Family Health Survey (NFHS is equivalent to the Demographic and Health Survey in India) have come under the scrutiny of researchers and policy makers globally. Using four waves (1992-93, 1998-99, 2005-06, and 2015-16) of published NFHS reports, this article aims to highlight the change in Contraceptive Prevalence Rate (CPR) and initiate a discussion to help investigate the reasons for the recent decline of CPR.
Keywords: Family Planning, Women, Contraception, Fertility, Demographic and Health Survey
1
Background Select estimates of contraceptive use in the 2015-16 National Family Health Survey (NFHS is equivalent to the Demographic and Health Survey in India) [1] have come under the scrutiny of researchers and policy makers. This time, the story line was to speculate the reasons for the declining trend of the Contraceptive Prevalence Rate (CPR) between 2005-06 and 2015-16. NFHS has been a major policy guiding national survey report for the Indian government [2]; Earlier reports of NFHS show an increasing trend of CPR during 1992-2006; however, there has been a decline from 56.3 percent in 2005-06 to 53.5 percent in 2015-16 for any method, and a downward trend for the modern method of contraception as well [1]. These statistics are alarming.
Family planning, or the practice of using contraceptives, is not only deemed a function of fertility preferences – birth spacing and limiting, but also plays a crucial role in addressing all eight Millennium Development Goals [3]. Its continued importance in achieving some targets of the Sustainable Development Goals cannot be denied [4]. As described in the United Nations Declaration of Human Rights, the use of contraceptives helps women and couples have the number of children they want, when they want them. In addition, the use of contraception leads to reduction in pregnancy related risk, teenage pregnancies and child mortality. Although CPR had decreased during 2005-2016, a decline in total fertility rate (TFR) from 2.7 in 2005-06 to 2.2 in 2015-16 was registered [1]. India is close to meeting the target of below replacement level fertility rate (TFR of 2.1 lifetime birth per woman), but it still bears an unacceptably high burden
2
of unwanted fertility, which could be avoided through effective use of contraception. Inconsistencies in the relationship between CPR and TFR have been experienced in some south Asian countries such as Bangladesh [5], but to establish concordance between declining CPR and falling TFR in India requires deeper investigation. Bongaarts’s framework about determinants of fertility regards contraceptive use as a deliberate marital fertility control factor, and the absence of contraception (and induced abortion) implies the existence of natural fertility [6]. Using four waves (1992-93, 1998-99, 2005-06, and 2015-16) of published NFHS reports, this article aims to highlight the change in CPR and initiate a discussion to help investigate the reasons for its recent decline.
Trends in Contraceptive Use Before comparing estimates of CPR from NFHS reports, it is important to understand the way in which questions are asked and estimates computed. In NFHS, currently married women (including women who were not pregnant or were unsure about pregnancy during the survey) were asked by an interviewer, “Are you currently doing something or using any method to delay your pregnancy or avoid getting pregnant?”, and if the answer was affirmative, the follow-up question was, “Which method are you using?”[7]. The guideline reads that interviewers might have to “probe to determine that the method is being used currently” [8]. Although, the guideline emphasizes the word, ‘currently’, it does not provide a reference period for it, which might lead to a biased response. For example, if a couple’s recent sexual intercourse was (say) 90 days preceding the survey date and they used coitus-related methods such as condoms, vaginal methods and withdrawal, it was unclear whether the use of contraceptives could be termed
3
‘current use’. It is possible that NFHS survey participants responded to this question arbitrarily and a significant proportion of respondents had misclassified their response as negative.
India was the first country to introduce its National Family Planning Programme in 1952, but it struggled to upscale its implementation. Till date, there has been intense discourse, (primarily on paper), on strengthening India’s family planning programme, which includes creating a domestic policy and being signatory to an international commitment; this has helped to some extent. In a recent move, the 2017 National Health Policy[9] aims to “meet (the) need of family planning above 90 percent at national and sub-national levels by 2025”, against the current unmet need of nearly 13 percent. Between 1992-93 and 2015-16, the CPR for any method and modern method, increased 13 percent and 11.5 percent, respectively (Table 1) varying by state, where Kerala reported the highest in CPR for any method in 1992-93, and West Bengal reported the highest in 2015-16. But the decline in CPR for both methods between 2005-06 and 2015-16 gives cause to ponder. When estimates of CPR were compared for 28 states, 18 states registered a decline in CPR for both/any method and modern methods of contraception (Figure 1). It was surprising that some developed states like Kerala and Delhi performed worse than Uttar Pradesh did (Uttar Pradesh is considered one of the high focus group states in need of special attention) in terms of direction of change in CPR. During the same period, prevalence of female sterilization, male sterilization and use of intrauterine device (IUD)/postpartum IUD (PPIUD) decreased, whereas an increasing trend was observed for the use of condoms and pills (Figure 2).
Until the NFHS dataset is available for analysis, it is too early to pinpoint the exact reasons for the overall decline in CPR. What about the performance of the public healthcare service sector
4
that caters to a big chunk of population, especially in rural India? During 2005-06, over 70 percent of all contraceptives were obtained from the public medical sector [10] and this figure is expected to rise, but it is discouraging to note that only about 18 percent of total female non-users (46.5 percent) were engaged in any discussion about family planning with health workers [1]. This suggests that very few community health workers (CHWs) follow the guidelines for distributing contraceptives and conducting counseling for contraceptive uptake. Decline in both male and female sterilization probably contributes to the highest share in decline in CPR. As couples are opting for fewer children, perhaps CHWs or counselors are not encouraging clients to opt for permanent sterilization. The government’s guideline indicates that in order to conduct a male or female sterilization, woman/man/couple “should have at least one child, whose age is above one year, unless the sterilization is medically indicated” [11, 12]. But what if there is sex preference or preference in the composition of children? An informed choice will not help increase the compliance for permanent sterilization, as a man/woman/couple may want to keep the option open to beget a child of their desired sex in the future. Besides, people may not opt for a permanent method because they want to have the option of having children as a measure of fertility risk management, in case of death of their child/children. This reasoning perhaps prompts people to opt out of permanent sterilization, and in the face of falling fertility, it accounts for the decline in overall CPR in India; again, this leads to prolonged fecundity. On the other hand, a reduction in the use of IUD/PPIUD could be attributed to the extent of access to medical facility for IUD/PPIUD insertion, given that the counseling for it is conducted properly. The insertion and removal of IUD/PPIUD requires a skilled provider with proper counseling of clients [13], but all public facilities are not equipped with trained medical officers and nurses to perform the procedure. In a four-tier facility in India (Sub Centre, Primary Healthcare Centre,
5
Community Healthcare Centre, and District Hospital), it is doubtful if skilled personnel are available at all levels of public health care institutions, and if the counseling is done properly.
Concluding Remarks The declining trend of CPR during 2005-16 demands urgent attention by researchers and policy makers. Although the total fertility rate has reduced to 2.2, the reduction in CPR may lead to inflated unwanted fertility in the future. People seem to want to prolong their fecundity as a measure to attain their desired fertility and to manage their future risk of fertility. Thus, with increasing risk of higher fertility, India might witness poor maternal and child health outcome and this adverse consequence on health would lead to financial burden. As an immediate measure, the Government of India should undertake an initiative to assess the extent of access to contraception. As health is a state subject, all the states in India should focus on up-scaling modern spacing methods for greater user satisfaction.
References [1] International Institute for Population Sciences. National Family Health Survey 2015-16: India Fact Sheet. International Institute for Population Sciences: Mumbai; 2017. [2] Dandona R, Pandey A, Dandona L. A review of national health surveys in India. Bull World Health Organ 2016; 94(4): 286–296A. [3] Cates W Jr, Abdool Karim Q, El-Sadr W, Haffner DW, Kalema-Zikusoka G, Rogo K, Petruney T, Averill EM. Family planning and the Millennium Development Goals. Science 2010; 329 (5999): 1603.
6
[4] Starbird E, Norton M, Marcus R. Investing in family planning: key to achieving the Sustainable Development Goals. Glob Health Sci Pract 2016; 4(2): 191-210. [5] Saha UR, Bairagi R. Inconsistencies in the relationship between contraceptive use and fertility in Bangladesh. Int Fam Plan Perspect 2007; 33(1): 31-37. [6] Bongaarts J. A framework for analyzing the proximate determinants of fertility. Popul Dev Rev 1978; 4(1): 105-132. [7] International Institute for Population Sciences. National Family Health Survey 2015-16: Woman’s Questionnaire. International Institute for Population Sciences: Mumbai; 2014. [8] International Institute for Population Sciences. National Family Health Survey 2015-16: Interviewer’s Manual. International Institute for Population Sciences: Mumbai; 2014. [9] Ministry of Health and Family Welfare. National Health Policy. Ministry of Health and Family Welfare, Government of India: New Delhi; 2017. [10]
International Institute for Population Sciences. National Family Health Survey
2005-06: National Report. International Institute for Population Sciences: Mumbai; 2007. [11]
Ministry of Health and Family Welfare. Reference Manual for Male Sterilization.
Ministry of Health and Family Welfare, Government of India: New Delhi; 2013. [12]
Ministry of Health and Family Welfare. Reference Manual for Female
Sterilization. Ministry of Health and Family Welfare, Government of India: New Delhi; 2014. [13]
Ministry of Health and Family Welfare. IUCD Reference Manual for Medical
Officers and Nursing Personnel. Ministry of Health and Family Welfare, Government of India: New Delhi; 2013.
7
Table 1 Current Use of Contraceptives in India, National Family Health Survey (NFHS), 1992-2016
India Delhi Haryana Himachal Pradesh Jammu region of Jammu & Kashmir Jammu & Kashmir Punjab Rajasthan Uttarakhand Chhattisgarh Madhya Pradesh (including Chhattisgarh) Madhya Pradesh (excluding Chhattisgarh) Uttar Pradesh (including Uttarakhand) Uttar Pradesh (excluding Uttarakhand) Bihar (including Jharkhand) Bihar (excluding Jharkhand) Jharkhand Odhisa West Bengal Arunachal Pradesh Assam Manipur Meghalaya Mizoram Nagaland Sikkim Tripura
NFHS 1992-93 Any Any Method Modern Method 40.6 36.3 60.3 54.6 49.7 44.3 58.4 54.4 49.4 39.7 na na 58.7 51.3 31.8 30.9 na na na na 36.5 35.5 na na 19.8 18.5 na na 23.1 21.6 na na na na 36.3 34.6 57.4 37.3 23.6 19.3 42.8 19.8 34.9 24.1 20.7 15.1 53.8 52.9 13.0 13.0 na na 56.1 28.6
NFHS 1998-99 Any Any Method Modern Method 48.2 42.8 63.8 56.3 62.4 53.2 67.7 60.8 na na 49.1 41.7 66.7 53.8 40.3 38.1 na na na na 44.3 42.6 na na 28.1 22.0 na na 28.1 22.4 na na na na 46.8 40.3 66.6 47.3 35.4 32.8 43.3 26.6 38.7 25.9 20.2 15.5 57.7 57.1 30.3 24.2 na na 53.8 41.4 8
NFHS 2005-06 Any Any Method Modern Method 56.3 48.5 66.9 56.5 63.4 58.3 72.6 71.0 na na 52.6 44.9 63.3 56.1 47.2 44.4 59.3 55.5 53.2 49.1 na na 55.9 52.8 na na 43.6 29.3 na na 34.1 28.9 35.7 31.1 50.7 44.7 71.2 49.9 43.2 37.3 56.5 27.0 48.7 23.6 24.3 18.5 59.9 59.6 29.7 22.5 57.6 48.7 65.7 44.9
NFHS 2015-16 Any Any Method Modern Method 53.5 47.8 53.0 47.3 63.7 59.4 57.0 52.1 na na 57.3 46.1 75.8 66.3 59.7 53.5 53.4 49.3 57.7 54.5 na na 51.4 49.6 na na 45.5 31.7 na na 24.1 23.3 40.4 37.5 57.3 45.4 70.9 57.0 31.7 26.6 52.4 37.0 23.6 12.7 24.3 21.9 35.3 35.3 26.7 21.4 46.7 45.9 64.1 42.8
Goa Gujarat Maharashtra Andhra Pradesh (including Telangana) Andhra Pradesh (excluding Telangana) Telangana Karnataka Kerala Tamil Nadu
47.8 49.3 53.7 47.0 na na 49.1 63.3 49.8
37.9 46.9 52.2 46.5 na na 47.3 54.4 45.2
47.5 59.0 60.9 59.6 na na 58.3 63.7 52.1
na: not applicable / available.
9
35.9 53.3 59.9 58.9 na na 56.5 56.1 50.3
48.2 66.6 66.9 67.6 na na 63.6 68.6 61.4
37.2 56.5 64.9 67.0 na na 62.5 57.9 60.0
26.3 46.9 64.8 na 69.5 57.2 51.8 53.1 53.2
24.8 43.1 62.6 na 69.4 56.9 51.3 50.3 52.6
Figure 1 Percentage Point Change in the Use of Any Method and Any Modern Method, National Family Health Survey, 2005-16
Figure 2 Change in Select Modern Contraceptive Use in India, National Family Health Survey (NFHS), 1992-2016 10
Decline in Contraceptive Use in India: A Call for Action
Highlight
1. Between 1992-93 and 2015-16, the Contraceptive Prevalence Rate (CPR) for any method and modern method, increased 13 percent and 11.5 percent, respectively.
2. Some developed states like Kerala and Delhi performed worse than Uttar Pradesh in terms of direction of change in CPR.
3. The Government of India should undertake measures to assess the extent of access to contraception.
11