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Published on July 24, 2014

Author: mumbaingos

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Vol. 58, No.1, June - 2012 1 Introduction India is the first country in the world to launch Family Planning Programme in 1952 (NPP, 2000). The central premise and rationale of Family Planning Programme was to enable individuals, particularly, women and couples to exercise control over their own fertility. However, in the early 60s, as the Government gradually became more concerned about curbing the rapid population growth, the national perspective overrides the individual needs. Population explosion increasingly caused worry to the Government about their ability to provide adequate level of health, education and other social services. Many approaches and strategies to improve the programme and to increase the contraceptive prevalence rate had been adopted. The Fifth Five Year Plan (1974-78) gave huge emphasis on sterilization, but due to the approach adopted for the programme, it suffered a serious setback in 1977. It became controversial and almost collapsed in 1977-78. In the ‘80s, India adopted the “cafeteria approach” to raise the prevalence of contraceptive methods among eligible couples. Despite this, the total number of women not practicing any form of contraception has hardly declined at all mainly due to the enormous increase in the number of women in the reproductive age group.1 According to the Census of India (2001), there are 2, 51,431,886 women (51 percent of total women) in the reproductive age (15- 49 years), 70 percent of them reside in rural areas. Among the rural women in reproductive age group, 36 percent are in the age group of 15-24 years and 18 percent are adolescents (below 20 years), 33 percent of the women aged 15-24 years are from eight Empowered Action Group (EAG) states, namely Uttaranchal, Rajasthan, CONTRACEPTIVE PRACTICES AND UNMET NEED AMONG YOUNG CURRENTLY MARRIED RURAL WOMEN IN EMPOWERED ACTION GROUP (EAG) STATES OF INDIA RANAJIT SENGUPTA AND ARPITA DAS Ranajit Sengupta is presently working in Technical Support Group (Condom Promotion) - NACO as Research Manager in Delhi and Arpita Das is Doctoral Fellow (JRF, GoI) at International Institute for Population Sciences (IIPS), Govandi Station Road, Deonar, Mumbai - 400 088.

2 The Journal of Family Welfare Uttar Pradesh, Bihar, Jharkhand, Orissa, Chhattisgarh and Madhya Pradesh. More than half of all the currently married women, aged 15-44 years are exposed to their first cohabitation at age less than 18 years and have two to three children by the age of 24 years (RCH-II). Many of them want to postpone or limit childbirth but are not using any kind of contraceptives. Besides, in the Indian context a woman is not empowered to take decisions on family planning or use of health care. Thus, there is wide gap in contraceptive knowledge, attitudes, and practices (KAP) between women’s reproductive intentions and contraceptive behaviours. Since the 1960s, survey data have indicated that substantial proportions of women who have wanted to stop or delay childbearing have not practiced contraception. This discrepancy or gap is referred to as the “unmet need” for family planning and has been defined and measured variously. Unmet need has been an important measure in family planning policy. As pointed out by Ashford,2 “This gap between women’s preferences and actions inspired many governments to initiate or expand family planning programs in order to reduce unintended pregnancies and lower the fertility rate. The term “unmet need” was coined in the late 1970s and has served ever since to gauge family planning needs in less developed countries.”2 Unmet need for family planning, therefore, refers to the proportion of married, fecund women who desire to space or limit their births but are not using contraception. Unmet need for family planning also refers to the non-use of contraception among women who would like to regulate their fertility, measured as the proportion of currently married women of reproductive age not using contraception but wishing either to postpone the next wanted birth or to prevent unwanted childbearing after having achieved their desired number of children. Approximately 120 million fecund women in the world are not using contraception. Almost half of women in low prevalence countries lack knowledge about contraceptives or have religious reservations about using them, while in countries of high contraceptive prevalence, health concerns are the major reason for non-use, followed by infrequent sex, and lack of knowledge.3 A study by Torres and Singh4 among the U.S population of Hispanic origin revealed that the Hispanic women of adolescent groups were least likely to use a contraceptive method at their first intercourse. A high level of unmet need for contraception persists among currently married women in South Asia. At least 1 in 5 currently married women in the countries surveyed want to stop or delay childbearing, but are not using contraception.5 The currently married Young women (15-24 years) in India form one of the largest groups with an unmet need for reproductive health services.6 Number of living sons, child loss, rural urban residence, education, media exposure and accessibility of family planning facility plays significant role in unmet need of Uttar Pradesh.7 Many scholars infer that the important reasons for non-use of contraception are lack of knowledge,8 fear of side effects, and social and familial disapproval,9 poor quality of care, and lack of choice in contraception available.10 Robey and others11 viewed that lack of access to service points as a primary reason for nonuse among the people, motivated for using. The result of the study by Puri, Garg and Mehra12 among married eligible women of 15-45 year in Slum clusters in urban Delhi revealed that opposition from husband’s/ families and male child preference was cited as the main reason for non use of contraception. Educated women have lower unmet need, but the husband’s education has no significant effect upon unmet need.

Vol. 58, No.1, June - 2012 3 Unmet contraceptive need rises as age and parity increase. Rural women have greater probability of having unmet contraceptive needs than urban women.13 Early age at marriage opens up a wider span of sexual exposure to the females and it is quite possible that most of them have two to three children by the age of twenty-four. “Too early, too frequent, too many” reproductive pattern leads to 33 percent births with an interval of less than 24 months, which results in high infant mortality.14 Premature babies with low birth weight, unwanted pregnancy terminated with induced abortion, maternal and child loss, pregnancy wastage, vulnerable health condition including reproductive morbidity are some other well-established consequences of conception at early ages. In this regard, it is relevant to pay extra attention to contraceptive behavior of currently married rural women between 15-24 years of age, simply because proper knowledge and high prevalence of appropriate use of contraceptive methods may protect this sensitive age group (15- 24) from unplanned pregnancy, early child bearing and high reproductive morbidity. But there is dearth of studies, which address the issue of contraceptive practice and unmet need for contraception among the young women, especially residing in rural areas. The main objective of this study is to examine the unmet need among the young currently married rural women in the EAG states of India. The specific objectives to: examine the differentials in the practice of various contraceptive methods; study the reasons and differentials of unmet need for contraception and find out the factors influencing unmet need for contraception for both spacing as well as limiting. Methodology The data for this analysis has been taken from District Level Household Survey (DLHS) under the Reproductive and Child Health Programme. The survey was conducted during the period 2002- 2004 in 593 districts of India. It covered a representative sample of 1000 households in each district. A total of 6,20,107 households were selected and out of those, around two thirds were rural households. For the purpose of the present analysis, data pertaining to 8 EAG states of DLHS has been used. The Empowered Action Group states (EAG States), which include Uttaranchal, Rajasthan, Uttar Pradesh, Bihar, Jharkhand, Orissa, Chhattisgarh and Madhya Pradesh, have been selected. The EAG states consist of 270,063 households. As the study is focussed only on rural young women; thus, for the study purpose, the urban women have been excluded and currently married women in the age group 15-24 have been selected. TABLE 1 Distribution of currently married young women in the EAG states, DLHS-2, 2002-04 State Frequency Percent Uttaranchal 1820 3.2 Rajasthan 8631 15.2 Uttar Pradesh 16054 28.2 Bihar 9704 17.1 Jharkhand 4043 7.1 Orissa 4915 8.6 Chhatisgarh 2764 4.9 Madhya Pradesh 8964 15.8 Total 56895 100 To study differentials in practice of different contraceptive methods in EAG states, bi-variate analysis has been carried out according to different socio-economic characteristics and availability-accessibility of health facilities. Multi-variate analysis is done to quantify the variation in unmet need for different socio economic and background characteristics as well as availability-accessibility of health facilities. The unmet need for spacing has been calculated by considering those currently married women, who are not pregnant,

4 The Journal of Family Welfare are menstruating, had not gone for hysterectomy, and who want more children after two years or more but currently not practicing any family planning methods. Women who are not sure about when to have (or whether to have) the next child have been included in the calculation of unmet need for spacing. The unmet need for limiting the child birth has been calculated by considering those currently married women, who are not pregnant, are menstruating, not gone for hysterectomy, and do not want any more children but currently not practicing any family planning methods. Total unmet need has been calculated as the sum of unmet need for spacing and unmet need for limiting. Results And Discussion Practice of different methods of contraception Different types of contraceptive methods have been grouped into three major categories, namely sterilization (includes female sterilization, tubectomy, laparoscopy, male sterilization, vasectomy and non scalpel vasectomy), modern methods for spacing between two successive births (intrauterine devices-IUD, oral contraceptive pills-OCP, condom, sponge- Today, injectable) and traditional methods (rhythmic, withdrawal, and ‘other traditional methods’) of family planning. In most of the EAG states, Muslim women have the least acceptance for sterilization. Very less proportion of young couple (less than 5 percent) among the schedule tribe (ST) population are sterilized in the states of Bihar, Jharkhand, Orissa and Rajasthan. Sterilization acceptance is highest among those couple, where only husbands are literate. Sterilization acceptance does not follow any specific pattern with respect to Standard of Living Index (SLI). With the increase in household SLI, the sterilization acceptance decreases in Orissa, Uttaranchal and Uttar Pradesh (Table 2). TABLE 2 Use of different types of contraceptive methods among currently married rural women aged 15-24 years in EAG states, DLHS-II Category Uttaranchal Rajasthan UP Bihar Sterili- Modern Tradi- Sterili- Modern Tradi- Sterili- Modern Tradi- Sterili- Modern Tradi- zation spacing tional zation spacing tional zation spacing tional zation spacing tional Religion Hindu 2.5 8.3 2.7 7.3 5.7 3.0 3.1 5.6 6.5 3.5 2.3 2.2 Muslim 11.5 2.9 3.2 6.4 2.8 0.6 5.6 4.7 0.7 2.1 2.5 Others 5.6 16.7 5.6 11.1 21.5 2.1 0.0 17.9 7.1 0.0 0.0 0.0 Caste SC 4.0 4.8 3.2 6.8 4.7 2.6 2.4 3.7 6.4 2.0 1.4 2.1 ST 2.4 11.9 4.8 4.7 5.2 3.0 3.7 2.1 7.4 1.2 1.7 1.7 OBC 0.9 10.2 2.7 8.2 6.0 3.1 2.9 5.6 6.1 3.5 2.1 2.0 Others 2.3 8.9 2.7 6.6 8.2 2.9 2.8 8.3 6.4 3.8 3.9 3.2 Couple’s education Both illiterate 2.1 4.3 2.8 6.4 3.1 2.4 2.1 2.7 5.4 2.2 0.9 1.8 Only husband lit. 5.5 4.9 4.1 8.0 3.9 2.8 3.4 4.3 6.4 3.5 1.4 1.8 Only wife literate 0.0 4.2 4.2 7.3 3.4 2.2 2.2 4.8 3.9 2.8 0.8 2.4 Both literate 1.6 10.2 2.4 6.3 12.3 3.7 2.5 9.3 7.0 4.0 4.7 3.0 Standard of Living Index Low 3.1 5.1 3.0 6.2 3.6 2.8 2.8 3.6 6.2 2.7 1.4 2.0 Medium 1.6 9.2 3.0 8.4 7.5 2.9 2.7 7.8 6.0 4.9 4.5 2.8 High 1.5 22.3 1.0 8.3 15.3 3.8 2.6 15.5 7.8 4.6 9.4 4.6

Vol. 58, No.1, June - 2012 5 Category Uttaranchal Rajasthan UP Bihar Sterili- Modern Tradi- Sterili- Modern Tradi- Sterili- Modern Tradi- Sterili- Modern Tradi- zation spacing tional zation spacing tional zation spacing tional zation spacing tional Son ever born <=1 0.8 8.3 2.3 2.3 5.9 2.9 0.7 5.2 5.8 0.7 2.1 2.1 2-3 19.0 10.8 8.2 33.0 6.8 3.1 12.8 7.7 8.7 16.5 3.1 3.1 > 3 15.0 2.5 2.5 16.8 5.3 8.4 21.3 Child loss No 2.2 8.6 2.6 7.0 6.2 3.1 2.6 5.7 6.2 3.1 2.4 2.3 Yes 5.0 8.0 5.0 8.2 4.5 1.9 3.6 4.8 6.5 3.7 1.1 1.9 Category Jharkhand Orissa Chhattisgarh MP Sterili- Modern Tradi- Sterili- Modern Tradi- Sterili- Modern Tradi- Sterili- Modern Tradi- zation spacing tional zation spacing tional zation spacing tional zation spacing tional Availability of health facility No 2.7 6.4 2.1 6.8 4.5 3.0 2.6 5.0 6.3 3.4 1.7 2.0 Yes 2.1 10.2 3.3 7.2 6.4 2.9 2.8 5.8 6.3 3.1 2.5 2.3 Accessibility of any health facility No 1.4 4.5 2.1 7.7 7.7 0.9 5.7 3.3 1.9 1.0 1.8 Yes 2.7 9.5 2.9 7.0 6.0 3.0 2.9 5.5 6.7 3.6 2.5 2.3 Religion Hindu 5.2 3.2 1.8 5.0 8.8 8.0 6.8 3.9 2.7 8.9 5.1 1.9 Muslim 1.2 4.3 1.5 3.6 16.4 9.1 5.9 5.9 5.9 5.6 7.5 2.3 Others 0.9 1.8 1.8 4.0 10.3 4.8 4.0 20.0 4.0 9.0 10.3 0.0 Caste SC 4.9 3.1 1.7 5.5 7.3 9.2 8.1 3.2 2.3 5.9 4.0 2.1 ST 2.4 2.4 1.2 3.4 4.7 6.3 4.7 3.6 2.4 8.3 2.5 1.2 OBC 5.2 3.6 2.0 5.6 10.6 8.5 8.7 4.2 3.0 10.3 6.2 2.0 Others 5.0 5.0 2.2 6.6 18.2 8.6 2.1 8.3 4.1 8.8 8.1 2.4 Couple’s education Both illiterate 3.7 0.9 1.1 6.3 3.2 5.9 6.4 1.7 3.1 8.6 2.2 1.7 Only husband lit. 5.2 1.9 1.3 5.4 6.2 7.9 7.6 2.5 3.4 10.2 4.0 1.9 Only wife literate 1.9 2.8 1.9 5.4 8.4 5.9 6.5 3.7 0.9 5.6 3.7 2.9 Both literate 4.8 7.5 3.0 3.7 14.6 9.6 6.5 6.1 2.4 8.0 9.1 2.0 Standard of Living Index Low 3.9 2.2 1.3 5.1 6.6 7.4 6.8 2.6 2.6 8.2 2.6 1.9 Medium 8.0 8.3 3.6 4.7 15.3 9.3 7.4 6.6 2.6 10.5 8.7 1.8 High 4.1 14.4 9.3 4.0 25.8 11.6 3.0 17.8 7.9 8.6 19.9 2.6 Son ever born <=1 1.5 3.3 1.5 2.4 8.5 7.6 3.2 4.1 2.3 3.6 5.5 1.9 2-3 20.2 4.1 3.3 22.1 11.5 10.2 28.2 4.0 5.9 35.0 3.9 2.0 > 3 26.7 31.3 6.3 6.3 71.4 33.3 3.3 Child loss No 4.4 3.5 1.7 4.9 8.9 7.9 6.4 4.3 2.7 8.9 5.5 2.0 Yes 5.1 2.3 2.3 5.3 9.0 8.1 9.8 1.8 3.2 8.4 3.0 1.5 Availability of health facility No 3.3 3.0 1.3 5.4 7.4 7.8 8.8 4.2 4.0 8.5 4.4 1.8 Yes 5.2 3.6 2.1 4.8 9.4 7.9 6.3 4.0 2.5 8.8 5.4 1.9 Accessibility of any health facility No 3.6 2.6 2.4 12.9 6.0 8.1 4.2 5.4 7.6 2.8 1.4 Yes 4.7 3.3 1.7 5.2 8.8 8.1 6.7 4.1 2.5 9.0 5.5 2.1

6 The Journal of Family Welfare Sterilization acceptance shows steady increase with the increase in the number of son ever born but it was found to be low among women who have experienced child loss. Women, who access any kind of health facility throughout the year, have higher acceptance of sterilization compared to those who did not access a health facility. In Jharkhand, young women from other religious groups showed the least acceptance of (2%) any modern spacing method of contraception. On the other hand, the percentage was highest among Muslims in Orissa (16%). Acceptance of modern method for spacing was lowest (1%) among the women in Jharkhand where couples were illiterate. The practice of modern spacing methods increases from low to medium SLI category but the increase is pretty steep and doubles among women with a high standard of living index. Among young women having at the most three sons, practice of modern spacing method increases with increase in number of sons ever born. But in case of more than 3 sons, acceptance decreases in most of the EAG states. Modern spacing was found to be less prevalent among women with one or more child loss than those who did not have any child loss. Use of modern spacing method increased with availability of health facility in the village. Traditional method is most prevalent among the Muslims of Orissa (9%), though it does not differ much by other socio- economic variables. Unmet need for contraception Table 3 shows the extent of unmet need in different EAG states. Jharkhand (39%), Bihar (37%) and Uttar Pradesh (35%) are top three states with higher unmet need. In Uttaranchal, unmet need for contraception is 30 percent, and ranges from 18 in Chamoli district to 38 percent in Hardwar district. In Orissa, it ranges from 9 percent to 36 percent. Rajasthan has highest unmet need in Dungarpur district (42%) and the lowest of 8 percent in Hamumangarh district. In Chhattisgarh, it ranges from 16 percent in Dantewara to 37 percent in Janjgir-Champa. West Nimar is the district with lowest unmet need (10%) in Madhya Pradesh. Rae Bareli of Uttar Pradesh, Sheohar and Katihar of Bihar; Gumla, Pashchimi Singhbhum and Kodarma in Jharkhand are the districts where unmet need is more than fifty percent. TABLE 3 Unmet need for contraception among rural young currently married women: EAG States, DLHS-II Total Total Total Total    State/District Unmet Women   State/District Unmet Women Need Need Uttaranchal 29.5 1820 Bihar 37.3 9704 Almora 35.8 148 Araria 38.9 239 Bageshwar 25.2 139 Aurangabad 30.5 315 Chamoli 21.1 114 Banka 40.1 252 Champawat 25.2 163 Begusarai 38.5 244 Dehradun 35.5 76 Bhagalpur 39.7 232 Garhwal 25.9 139 Bhojpur 34.5 249 Hardwar 37.5 128 Buxar 36.9 279 Nainital 36.9 141 Darbhanga 46.7 270 Pithoragarh 30.7 140 Gaya 36.9 268 Rudraprayag 32.6 172 Gopalganj 29.5 302 Tehri Garhwal 27.0 141 Jamui 30.7 280 Udham Singh Nagar 27.5 167 Jehanabad 43.1 218

Vol. 58, No.1, June - 2012 7 Total Total Total Total    State/District Unmet Women   State/District Unmet Women Need Need Uttarkashi 25.0 152 Kaimur (Bhabua) 32.4 238 Rajasthan 25.8 8631 Katihar 50.9 234 Ajmer 33.0 215 Khagaria 33.9 224 Alwar 17.9 290 Kishanganj 46.5 172 Banswara 29.5 302 Lakhisarai 31.3 262 Baran 34.2 234 Madhepura 40.9 235 Barmer 34.8 287 Madhubani 33.5 278 Bharatpur 22.0 328 Munger 40.6 219 Bhilwara 28.7 279 Muzaffarpur 37.7 204 Bikaner 29.9 304 Nalanda 30.1 249 Bundi 28.1 267 Nawada 46.1 284 Chittaurgarh 41.2 284 Pashchim Champaran 32.0 419 Churu 26.9 320 Patna 45.3 179 Dausa 20.6 248 Purba Champaran 40.9 291 Dhaulpur 23.3 245 Purnia 23.2 190 Dungarpur 42.3 222 Rohtas 29.0 245 Ganganagar 11.2 285 Saharsa 42.5 294 Hamumangarh 10.3 302 Samastipur 42.0 441 Jaipur 18.6 172 Saran 31.4 261 Jaisalmer 35.9 351 Sheikhpura 38.4 224 Jalor 21.5 317 Sheohar 52.0 273 Jhalawar 31.2 260 Sitamarhi 38.1 265 Jhunjhunun 33.3 270 Siwan 38.4 258 Jodhpur 15.1 311 Supaul 23.7 295 Karauli 17.0 265 Vaishali 39.4 322 Kota 18.5 178 Jharkhand 38.5 4043 Nagaur 28.6 259 Bokaro 36.7 215 Pali 20.5 254 Chatra 48.5 262 Rajsamand 24.9 205 Deoghar 35.5 234 Sawai Madhopur 18.2 242 Dhanbad 28.7 174 Sikar 28.4 331 Dumka 33.2 223 Sirohi 40.3 243 Garhwa 37.3 271 Tonk 13.4 277 Giridih 31.8 314 Udaipur 26.4 284 Godda 31.5 381 Uttar Pradesh 34.5 16054 Gumla 61.5 143 Agra 28.3 127 Hazaribagh 45.6 250 Aligarh 24.2 194 Kodarma 51.8 282 Allahabad 27.2 243 Lohardaga 49.7 177 Ambedaker Nagar 39.7 277 Pakaur 25.5 208 Auraiya 29.5 176 Palamu 23.0 213 Azamgarh 43.1 320 Pashchimi Singhbhum 55.4 157 Baghpat 20.9 196 Purbi Singhbhum 42.3 123 Bahraich 39.3 285 Ranchi 35.2 165 Ballia 39.8 246 Sahibganj 34.3 251

8 The Journal of Family Welfare Total Total Total Total    State/District Unmet Women   State/District Unmet Women Need Need Balrampur 35.7 266 Orissa 23.0 4915 Banda 28.5 239 Anugul 32.7 199 Barabanki 35.5 242 Balangir 21.6 185 Bareilly 34.4 180 Baleshwar 23.9 197 Basti 32.2 264 Bargarh 21.3 164 Bijnor 28.8 125 Baudh 23.0 174 Budaun 33.0 203 Bhadrak 28.9 142 Bulandshahar 32.2 180 Cuttack 16.2 117 Chandauli 28.9 311 Debagarh 28.7 171 Chitrakoot 25.3 316 Dhenkanal 15.7 159 Deoria 22.0 286 Gajapati 17.6 182 Etah 26.3 190 Ganjam 25.9 201 Etawah 28.5 172 Jagatsinghapur 14.8 108 Faizabad 38.1 239 Jajapur 24.8 137 Farrukhabad 22.2 153 Jharsuguda 18.6 129 Fatehpur 31.6 231 Kalahandi 20.1 184 Firozabad 36.8 185 Kandhamal 22.8 167 Gautam Buddha Nagar 34.2 161 Kendrapara 25.9 116 Ghaziabad 37.9 116 Kendujhar 35.7 154 Ghazipur 38.1 307 Khordha 25.7 140 Gonda 45.5 299 Koraput 22.3 188 Gorakhpur 34.8 296 Malkangiri 13.3 256 Hamirpur 33.5 215 Mayurbhanj 29.9 187 Hardoi 33.3 207 Nabarangapur 21.9 228 Hathras 25.8 186 Nayagarh 27.8 169 Jalaun 27.2 268 Nuapada 21.8 179 Jaunpur 43.0 344 Puri 20.3 128 Jhansi 31.7 246 Rayagada 22.6 155 Jyotiba Phule Nagar 44.4 180 Sambalpur 25.7 113 Kannauj 33.1 172 Sonapur 22.4 156 Kanpur Dehat 36.1 244 Sundargarh 16.2 130 Kanpur Nagar 32.7 55 Madhya Pradesh 25.2 8964 Kaushambi 41.6 226 Balaghat 24.6 138 Kheri 37.1 286 Barwani 17.3 283 Kushinagar 30.5 295 Betul 29.4 153 Lalitpur 35.0 323 Bhind 40.0 195 Lucknow 36.7 109 Bhopal 23.3 73 Maharajganj 39.3 308 Chhatarpur 41.8 194 Mahoba 27.3 198 Chhindwara 21.5 186 Mainpuri 30.3 178 Damoh 25.1 175 Mathura 31.8 245 Datia 25.9 174 Mau 36.5 249 Dewas 25.8 279 Meerut 27.5 138 Dhar 17.6 272 Mirzapur 34.8 276 Dindori 29.8 238

Vol. 58, No.1, June - 2012 9 Total Total Total Total    State/District Unmet Women   State/District Unmet Women Need Need Moradabad 36.8 212 East Nimar 26.0 223 Muzaffarnagar 23.6 195 Guna 24.1 261 Pilibhit 33.2 226 Gwalior 32.4 102 Pratapgarh 38.3 290 Harda 20.1 174 Rae Bareli 51.3 195 Hoshangabad 14.8 169 Rampur 37.2 180 Indore 19.8 106 Saharanpur 37.3 150 Jabalpur 35.5 110 Sant Kabir Nagar 34.0 235 Jhabua 26.0 223 Sant Ravidas Nagar 36.3 380 Katni 28.7 174 Shahjahanpur 41.0 173 Mandla 24.0 183 Shrawasti 34.1 279 Mandsaur 20.5 224 Siddharthnagar 43.1 262 Morena 11.5 200 Sitapur 48.0 271 Narsimhapur 26.0 235 Sonbhadra 35.1 279 Neemuch 18.7 230 Sultanpur 42.9 282 Panna 23.0 178 Unnao 30.8 221 Raisen 27.3 187 Varanasi 32.3 251 Rajgarh 24.3 239 Chhatisgarh 26.6 2764 Ratlam 18.5 238 Bastar 36.7 177 Rewa 35.0 177 Bilaspur 33.7 190 Sagar 38.8 188 Dantewada 20.2 84 Satna 25.7 187 Dhamtari 22.4 165 Sehore 23.9 226 Durg 29.6 162 Seoni 23.4 184 Janjgir-Champa 37.3 153 Shahdol 30.2 222 Jashpur 23.5 136 Shajapur 23.9 218 Kanker 26.8 142 Sheopur 17.7 147 Kawardha 20.0 250 Shivpuri 18.1 210 Korba 25.1 183 Sidhi 32.9 231 Koriya 28.6 220 Tikamgarh 28.9 204 Mahasamund 21.3 211 Ujjain 20.2 242 Raigarh 20.5 132 Umaria 40.4 228 Raipur 30.4 138 Vidisha 31.0 255 Rajnandgaon 29.3 174 West Nimar 12.2 229 Surguja 21.1 247 Table 4 indicates that the level of unmet need for spacing is relatively high as compared to that of limiting. The total unmet need for contraception was found to be maximum among Muslim women in Bihar (42%), among ST women in Jharkhand the total unmet need is the highest (43%). In most of the EAG states the maximum proportion of total unmet need is concentrated among illiterate couples. Women with low SLI was found to have higher proportion of total unmet need for contraception as compared to women with medium and high SLI. Unmet need to limit birth increases among women with at least one child loss. With increasing number of sons ever born, the highest percentage of unmet need was for limiting birth methods. The unmet need did not differ much with availability and accessibility of any health facility in the village.

10 The Journal of Family Welfare TABLE 4 Unmet need for different contraceptive methods among currently married rural women aged 15-24 years in EAG States, DLHS-II Category Uttaranchal Rajasthan UP Bihar Spacing Limiting Spacing Limiting Spacing Limiting Spacing Limiting N = 1820 N = 8631 N = 16054 N = 9704 Religion Hindu 22.2 6.9 18.8 7.1 26.0 8.1 27.3 9.4 Muslim 25.9 12.0 24.2 4.4 30.7 7.6 33.3 8.8 Others 15.8 – 6.7 4.7 16.7 3.3 30.0 – Caste SC 27.3 6.7 17.4 7.2 28.0 7.2 28.8 9.0 ST 7.1 11.9 19.5 8.6 24.2 7.9 28.9 9.2 OBC 27.0 9.0 18.5 6.2 26.5 8.3 27.7 9.2 Others 21.1 6.7 20.9 7.0 24.8 8.2 27.8 9.9 Couple’s Education Both Illiterate 25.9 13.3 21.1 7.9 28.2 8.1 26.9 10.2 Only husband literate 22.2 8.4 18.2 6.8 26.9 8.3 29.9 8.9 Only wife literate 20.0 8.0 19.3 6.1 30.1 7.5 26.9 7.1 Both Literate 22.1 6.1 17.9 6.3 24.5 7.6 28.0 9.0 SLI Low 21.7 7.1 20.1 7.3 27.7 8.0 28.7 9.1 Medium 25.0 7.4 17.4 6.7 24.8 8.2 25.8 10.0 High 16.6 6.3 16.5 5.7 22.0 7.6 23.9 10.5 Son ever born <=1 23.4 4.3 19.9 4.4 27.4 4.2 29.1 5.1 2-3 11.3 37.1 13.8 19.8 22.3 26.3 22.2 32.3 > 3 22.5 7.2 9.8 41.5 16.5 34.0 20.4 36.7 Child loss No 19.8 6.9 19.2 6.5 26.5 7.5 28.1 8.9 Yes 21.4 7.1 16.4 10.6 26.5 11.2 27.2 12.9 Availability of health facility No 23.1 7.2 20.0 7.2 25.6 7.5 27.3 8.9 Yes 23.2 8.0 18.6 6.8 26.8 8.1 28.3 9.5 Accessibility of any health facility No 21.6 7.0 15.4 11.5 23.8 7.2 28.3 9.0 Yes 22.2 6.9 18.9 6.9 26.8 7.9 27.4 9.4

Vol. 58, No.1, June - 2012 11 Religion Hindu 29.6 9.0 15.4 7.6 20.1 6.4 17.2 7.9 Muslim 31.3 6.9 15.5 10.3 29.4 – 19.3 10.3 Others 33.6 2.7 10.2 9.4 16.0 8.0 16.5 8.9 Caste SC 31.0 8.7 13.8 7.7 22.6 8.0 17.2 7.3 ST 32.7 9.9 16.2 7.2 19.5 5.9 17.3 8.0 OBC 29.2 7.8 15.7 8.3 19.8 6.5 16.5 8.4 Others 25.2 8.1 13.8 7.3 22.3 5.4 19.2 7.6 Couple’s Education Both Illiterate 31.9 7.6 15.1 7.0 20.2 6.2 17.7 7.6 Only husband lit. 30.1 8.7 15.7 9.7 20.3 6.8 16.2 8.5 Only wife literate 26.2 5.6 14.8 7.0 20.0 9.1 19.3 7.3 Both Literate 28.0 9.5 18.2 7.2 20.1 6.0 17.7 7.8 SLI Low 31.3 8.3 15.7 8.2 20.2 6.6 18.3 7.9 Medium 23.0 9.9 13.8 6.2 20.1 6.0 15 8.3 High 25.0 6.0 13.2 5.4 20.6 4.9 15.3 7.3 Son ever born <=1 30.7 5.0 15.7 5.6 21.1 3.9 18.6 5.5 2-3 26.0 27.0 12.8 22.0 14.2 22.3 11.1 20.3 > 3 18.8 37.5 – 25.0 14.3 14.3 3.3 33.3 Child loss No 30.1 8.0 15.5 7.5 20.5 6.3 17.3 7.6 Yes 29.0 12.3 13.5 9.1 17.1 7.7 16.9 10.3 Availability of health facility No 30.5 8.6 13.7 8.3 18.5 7.2 17.0 7.5 Yes 29.6 8.4 15.8 7.5 20.5 6.2 17.4 8.1 Accessibility of any health facility No 28.9 8.7 7.4 11.6 15.9 8.4 19.2 8.0 Yes 29.9 8.6 15.5 7.6 20.3 6.1 16.5 7.8 Total 30.0 8.5 15.3 7.7 20.2 6.4 17.3 8.0 Category Uttaranchal Rajasthan UP Bihar Spacing Limiting Spacing Limiting Spacing Limiting Spacing Limiting N = 4043 N = 4915 N = 2764 N = 8964 Reasons for not using contraception Table 5 gives the percentage of women giving various reasons for nonuse of spacing methods for contraception. Important reasons were husbands’ opposition, health related problems, lack of knowledge on proper contraceptive methods. In Bihar Jharkhand and M.P among all these reasons, opposition by husband was reported as the most prevalent reason for not using contraception. Chhatisgarh, Uttaranchal and U.P were the first three states where women not using contraceptives was because of health related problem. Women in Madhya Pradesh and Jharkhand stated lack of knowledge was one of the most frequently reported reasons for not using contraceptives.

12 The Journal of Family Welfare TABLE 5 Reason for not using contraceptive method among currently married rural women aged 15-24 years having an unmet need for contraception in EAG states, DLHS-II Reasons EAG States Uttaranchal Rajasthan UP Bihar Jharkhand Orissa Chhattisgarh MP Knowledge &Misconception Lack of knowledge 5.4 4.5 4.1 2.4 5.6 3.9 7.2 10.3 Afraid of sterilization 2.0 3.1 2.3 2.3 3.9 0.7 4.1 2.7 Cannot work after Sterilization 0.6 1.8 0.3 1.0 1.5 0.4 0.8 0.5 Opposition Against religion 1.3 1.2 3.9 5.4 5.4 1.5 0.8 1.0 Opposed to family planning 0.2 1.3 1.4 0.7 1.0 1.6 0.7 1.0 Husband opposed 4.1 4.8 7.8 28.0 25.5 6.1 7.4 8.6 Other people opposed 1.7 3.6 3.2 13.4 6.8 2.6 6.0 7.7 Method related problems Do not like existing methods 2.6 1.8 1.8 0.7 0.5 1.1 1.1 1.1 Costs too much 1.5 0.6 1.2 2.4 2.9 1.5 1.1 0.8 Hard/Inconvenient to get Method 0.9 1.3 1.9 1.7 1.5 1.9 0.7 2.4 Inconvenient to use method 0.4 0.7 0.5 0.6 0.5 1.0 1.8 1.0 Health related problems Worry about side effects 0.9 0.9 0.8 2.3 2.8 2.3 0.8 1.4 Health does not permit 14.2 4.8 8.1 5.6 7.9 7.2 17.2 5.5 Difficult to become pregnant 3.7 5.0 3.0 6.8 6.0 3.0 7.9 4.6 Other reasons 60.5 64.4 60.0 26.8 28.2 65.2 42.5 51.4 Determinants of unmet need for contraception Age of women, educational level of the couples, sons ever born, child loss, religion, SLI, households having electronic media and visit by FP workers are highly significant factors influencing the unmet need for spacing. State-wise difference were found. With increase in age, the unmet need for spacing increased significantly. Among currently married rural young (15- 24), Muslim women of EAG states, unmet need for spacing increased significantly by 23.5 percent compared to Hindu women. As the SLI rises, the unmet need for spacing reduced by 11 percent for medium and 16.5 percent for high SLI group. The unmet need for spacing reduced significantly by six percent among literate couples husbands, and illiterate women. With increasing number of sons ever born, unmet need for spacing increased by 15 percent. The unmet need decreased by nine percent for women with at least one child loss. The visit by FP worker raised the unmet need for spacing by nine percent. As age increases, the unmet need for spacing increases significantly. Among Muslim women and women from other religions, the unmet need for limiting reduced significantly by 23 percent and 32 percent respectively as compared to Hindu women. With increased in educational level of the couples, the unmet need for limiting increased significantly. In medium SLI group, the unmet need to limit increased by 11 percent, compared to women with low SLI. There was a three-fold increase in the unmet need for limiting among those women with increasing number of sons.

Vol. 58, No.1, June - 2012 13 The unmet need for limiting reduces by 48 percent among women with at least one child loss, compared to women with no child loss. Presence of electronic media reduced the unmet need for limiting by 11 percent, compared to their counterpart. TABLE 6 Odds ratios of unmet need for contraception according to background characteristics from logistic regression model Category Unmet Need Unmet Need for Spacing for Limiting Exp(B) Exp(B) Age 1.736 * 1.90 * Couple’s education Both Illiterate @ 1.000 1.000 Only Husband literate 0.936 ** 1.095 ** Only Wife literate 1.022 1.301 ** Both literate 0.975 1.263 *** Son Ever Born 1.147 * 2.886 * Child loss No @ 1.000 1.000 Yes 0.911 * 0.516 * Religion Hindu @ 1.000 1.000 Muslim 1.235 * 0.773 *** Others 0.714 * 0.679 * Caste Others @ 1.000 1.000 SC 0.999 0.914 ST 1.019 0.963 OBC 0.982 0.960 Standard of Living Index Low @ 1.000 1.000 Medium 0.889 * 1.114 ** High 0.835 * 0.973 Exposure to Electronic Media No @ 1.000 1.000 Yes 0.959 0.894 ** Availability of any Health Facility in Village No @ 1.000 1.000 Yes 1.031 1.016 Accessibility of Any Health Facility No @ 1.000 1.000 Yes 1.017 0.937 Distance from Health Centre Within 3 k.m. @ 1.000 1.000 More than 3 k.m 1.003 0.993 Visit by F.P. Worker No @ 1.000 1.000 Yes 1.093 ** 1.056 States Bihar @ 1.000 1.000 Uttaranchal 0.845** 0.744* Rajasthan 0.634* 0.667* Uttar Pradesh 0.968* 0.743* Jharkhand 1.114** 0.936 Orissa 0.499* 0.787* Chhattisgarh 0.673* 0.600* Madhya Pradesh 0.553* 0.731* @ Reference category *** p < 0.01; ** p<0.05; *p <0.10 Spacing Limiting Dependent variable 0= met need 0= met need for spacing for limiting Unmet need or 1= unmet need 1= unmet need spacing and Unmet for spacing for limiting need for limiting No. of cases 56895 56895 -2 log likelihood 55012.184 24211.117 R2 .033 .203 Conclusion This analysis indicates that a large proportion of married young women age 15-24 in the rural areas of EAG states are not using any kind of contraceptives. Among the EAG states the total unmet need is highest in Jharkhand, UP and Bihar (close to 40 percent). A substantial proportion of non-users either want to postpone or limit the Category Unmet Need Unmet Need for Spacing for Limiting Exp(B) Exp(B)

14 The Journal of Family Welfare child bearing, but exposed to the risk of pregnancy. Muslim women were found to be more vulnerable. Higher educational level of the couple, high standard of living, owning electronic media and visits by FP workers significantly influences the unmet need. References 1. United Nations Population Fund. 1991. Contraceptive requirements and demand for contraceptive commodities in developing countries in the 1990s, New York. 2. Ashford, L. 2003. Unmet need for family planning: Recent trends and their implications for programs. Policy Briefs, PRB, Washington, DC, USA. 3. Finger, W.R. 1994. A growing challenge: addressing “unmet need”, Network, Vol. 15, No. 1. 4. Torres, A. and Singh, S. 1986. Contraceptive practice among hispanic adolescents. Family Planning Perspective, Vol. 18, No. 4. 5. Choudhury, R.H. 2001. Unmet need for contraception in South Asia: Levels, trends and determinants. Asia-Pacific Population Journal, Vol. 16, no. 3. 6. Pachauri, S. and Santhya, K.G. 2002. Reproductive choices for Asian adolescents: A focus on contraceptive behaviour. International Family Planning Perspective, Vol. 28, No. 4. 7. Radha, D., Rastogi, S.R. and Ratherford, R.D. 1996. Unmet need for family planning in Uttar Pradesh. National Family Health Survey Subject Report. 8. Nichols, D., Ladipo, O.A., John P.M, and Otolorin, E.O. 1986. Sexual behaviour, contraceptive practice and reproductive health among Nigerian adolescents. Studies in Family Planning, Vol. 17, No. 2 9. Bongaarts, J. and Bruce, J. 1995. The causes of unmet need for contraception and the social content of services. Studies in Family Planning, Vol. 26, No. 2. 10. Zappella, M. 1997. Beyond access: Addressing the unmet need for family planning. People and Development Challenges, Vol. 4, No. 7. 11. Robey, B., Ross, J. and Bhushan, I. 1996. Meeting unmet need: New strategies. Population Reports: Family Planning Programs, Series J, Vol. 43. 12. Puri, A., Garg, S. and Mehra, M. 2004. Assessment of unmet need for contraception in an urban slum of Delhi. Indian Journal of Community Medicine, Vol. 29, No. 3. 13. Barket-e-Khuda and S. Howlader. 1986. Unmet need. Bangladesh Contraceptive Prevalence Survey - 1983, Special Topics, edited by Sarah Harbison and S.N. Mitra, 14. Mortezo, L.V. 1995. The unmet need and demand for modern contraception in the Philippines, Ann Arbor, Michigan, UMI Dissertation Services, Vol. XI, No. 2. n

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