Disparity in Contraceptive Use in India - Numbers Reveal Reality
An ASAR Data Story
By ASAR Blogs Team
Ideation & Drafting
Sharvari Mande, Anoushka Arora
Calculations & Visualisations
Sharvari Mande, Anoushka Arora, Parth Sharma
Review & Editing
Parth Sharma, Siddesh Zadey
“A human is killed by accident way less often than a child is made by mistake”
With 1.4 billion people, India is the second most populous country in the world. Overcrowding due to the rising population along with the scarcity of resources is affecting the health of the people. Contraception use and family planning are critical ways of managing the growing population. Contraceptive methods can be of two types - modern or traditional. Modern methods include surgical sterilization, contraceptive injections, oral pills, condoms, and intrauterine devices. Whereas, traditional methods include withdrawal (preventing semen deposition in the female reproductive tract) and avoiding sexual activity for specific periods of the month.
In 1952, India became the first country to initiate a National Programme for Family Planning. Family planning involves limiting the number of children and increasing the gap between two consecutive births, i.e., birth spacing. These have a positive impact on maternal and child health. Thanks to the programme, India has successfully brought down its population growth rate to 1% from 2.21% in the last seven decades.
In this ASAR Data Story, we use the data from the National Family Health Survey (NFHS) to focus on the disparity in contraceptive use between men and women and explore the socio-economic factors that determine the use of contraceptives in India. We assessed the use of modern methods as they require access to healthcare facilities, an adequate supply of required contraceptives, and awareness among the people.
1. What are the common methods of contraception used in India by men and women of the reproductive age group?
Female surgical sterilization (tubectomy), i.e., surgically disconnecting the path that transfers the ovum, was the most common method of contraception during sexual activity as reported by 38% of married women in India followed by the use of male condoms (9%). Male condoms (27%) were the most commonly used contraceptive during sexual intercourse as reported by unmarried women (Fig 1). 33% of married women and 45% of unmarried women reported not using any method of contraception. Only 0.3% of the sexually active males underwent surgical sterilization (vasectomy; a surgical procedure that disconnects the tube carrying the sperms and thus leads to the production of sperm less ejaculate) while 67% of them reported using no contraceptive during sexual activity.
2. What percentage of married women in India are using modern methods of contraception in rural vs urban areas across states?
We compared the use of modern methods of contraception in urban and rural India. 59.5% of Indian married women living in urban areas used modern contraceptive methods compared to 57.1% of rural women. Women in rural Andhra Pradesh (71.1%) had the highest modern contraceptive use while Manipur (17.5%) had the lowest (Fig 2). The same holds true for urban Andhra Pradesh (70.3%) and Manipur (19.3%).
3. What are the preferred methods of contraception in urban and rural areas in India?
The use of any method of contraception was lower in rural areas (65.6%) when compared with urban areas (69.3%). Modern methods of contraception were preferred in both urban and rural areas as compared with traditional methods. A greater proportion of the rural population reported the use of irreversible and invasive female surgical sterilization (38.6% in rural vs 36.3% in urban areas). Safer and reversible methods of contraception like condoms and intra-uterine devices were more commonly used in urban areas (Fig 3).
4. Has the unmet family planning need reduced over the years?
Unmet family planning is the percentage of sexually active women who currently do not want to get pregnant but nevertheless are not using any form of contraception. We assessed the trend of unmet family planning needs from NFHS-2 (1998-99) to NFHS-5 (2019-21).
We noticed that it reduced over the years for all states except Kerala, Gujarat, Mizoram, and Punjab (Fig 4). This could be partly attributed to a lack of awareness and fear of side effects as reported by a recent study done in Gujarat. Another study done in Kerala concluded that high unmet need was due to fear of complications, religious faith, lack of knowledge, and partner opposition. While in Punjab, the reasons could be low outreach of health workers, poor coverage of the family planning programme, and cultural norms discouraging women to use contraceptives.
5. Does the educational status of women and men affect the choice of modern contraception?
As women’s education level improved, they chose reversible and non-invasive methods over permanent and invasive methods of contraception. The percentage of women undergoing permanent surgical sterilization (tubectomy) decreased from 80.5% in women with no schooling to 44.4% in women with over 12 years of schooling. On the contrary, the use of condoms increased from 8.6% to 35.6% and the use of intrauterine devices increased from 1.5% to 7.2% (Fig 5). An increase in condom use could mean the appreciation of the prevention of sexually transmitted diseases (STDs) as an added benefit.
As the education level of men increased from no schooling to 12 or more years of schooling, condom use increased from 3.1% to 13.9% (Fig 6). The percentage of sexually active men undergoing surgical sterilization remained extremely low and was nearly the same across men with different education levels.
There is a clear gender disparity between sexually active men and married women of the same education level in the uptake of surgical sterilization. Female sterilization, i.e. tubectomy, is a more invasive procedure as compared to male sterilization, i.e. vasectomy. Among unschooled people, only 0.6% of men as opposed to 80.6% of women underwent surgical sterilization. At 12 or more years of schooling, the percentage of women undergoing surgical sterilization decreased to 44.4% from 80.6%, whereas no significant change was noticed in the percentage of men undergoing vasectomies (Fig 6).
6. Does socioeconomic status affect the choice of contraception in men and women?
The use of intrauterine devices (IUDs) doubled from 1.5% to 3.1% and the use of pills decreased from 7.2% to 2.9% as the wealth quintiles of women increased (Fig 7). Pills have more side effects when compared with IUDs. Therefore, it is possible that with an improvement in socioeconomic status, women prefer safer contraceptives with lesser side effects.
Moving from the lowest to highest wealth quintile, the only appreciable increase was seen in the use of male condoms, from 4.9% to 17.8% (Fig 8). The use of male surgical sterilization continued to be extremely low as compared to female sterilization.
As we see in this ASAR Data Story, family planning in India still has a huge scope for improvement. The focus of our family planning programmes should be on increasing the use of reversible methods like condoms in both urban and rural areas rather than invasive surgical methods as condoms are safer and also provide additional benefits of protection from STDs. As India’s public health sector is the major provider of family planning services to the poor, strengthening of public facilities, and human resource management should be emphasized to increase the use of modern contraceptives. The focus should also be on unmarried sexually active women, whose contraceptive needs are not met in the programme. Lastly, contraception should not be a women's burden alone but a responsibility that men should share with them equally.
Cite this article as:
Mande S, Arora A, Sharma P, Zadey S. Disparity in Contraceptive Use in India - Numbers Reveal Reality. 2022 Dec 4; Available from: https://www.asarforindia.org/post/Disparity-in-Contraceptive-Use-in-India-Numbers-Reveal-Reality.