Student Dissertation

Agency : Modern Contraceptive Use; CMWRA Bihar; Female Sterilizations

Objective : 1. To describe the pattern of modern contraceptive use among currently married women of the reproductive age group in Bihar. 2. To identify the socio-demographic characteristics pertaining to the modern contraceptive use among currently married women of the reproductive age group in Bihar.

Background : One of the most important pillars for women empowerment is to enable them to achieve freedom and control of their body. This can be ensured if they start using appropriate modern contraceptives through informed self-choice. As far as Bihar is concerned, total women population under reproductive age group (15 yrs to 49 yrs) is 23,042,786 and among them currently, married women are 18,572,000 as per census 2011. Considering this enormous numbers there is a great amount of opportunity for modern contraceptive, but the real scenario is totally different. As per the National Family Health Survey (NFHS) 2015-16, usage of a modern contraceptive method in Bihar is half (23.3) of our National average (47.8). The primary factors for low use of modern contraceptive could be low levels illiteracy among women population which is merely 51.50% (Census- 2011) and marriage at an early age, women age 20-24 years married before age 18 years in Bihar is as higher as 42.5% (NFHS 2015-16). There could be other factors also like women’s and her family’s socio-economic background, male child preference, relationship with husband, exposure to print and digital media and awareness, etc.

Methodology : Study area: all the districts of Bihar. Study design: Descriptive study based on secondary data analysis Data: This study used the data from round 1 of “Currently married women of reproductive age (CMWRA)” study conducted by Care India, Bihar, Concurrent monitoring and Learning (CML) unit in 2016 with objectives to understand the intent and practices among CMWRA across the areas of family planning including TFR, unmet need, CPR (Modern and Traditional), method mix of contraceptives and also to identify the reasons for non-usage of methods. The CMWRA was a state level representative survey of 22800 married women of reproductive age group (15-49 years) i.e, 600 per district. CMWRA survey adopted multistage cluster sampling with a systemic component in the final stage. Data Analysis: The analytical approach in this study includes descriptive analysis by using ratio, rate, and proportions. The data was analyzed on SAS 9.4 software with the focus to examine the differentials in various components of the utilization of various contraceptive methods (method mix) with different socio-economic & demographic independent variables. Variables: • Dependent- use of modern contraceptive • Independent- religion, caste, husband’s education, number of living children, economic status (asset index quartile), FP related decision-making, the status of the respondent, FP-related interaction with FLWs and ease of access to modern FP methods.

Findings : CMWRA survey was crucial to understanding intent and practice related to family planning among Married Women of Reproductive Age (MWRA) and areas like Total Fertility Rate. The intent of using Family Planning methods and also the reasons for non-usage of methods etc. Whereas understanding the social recognition of MWRA including- mobility, independence, self- respect and exposure to domestic violence was one of the important objectives of this survey, in the end, we can conclude with the key learnings we found after analyzing the data are. • The gap between mean age at first sex/ marriage and first contraceptive use is ~8 years. On average, women have 2.7 children by the time they first start using contraception • Female sterilizations still remain the most popular modern contraceptive method (over 90%) used across the state • Only half the population of Bihar are aware of temporary spacing methods like Pills, Male condoms, IUCDs and Injectables • Surprisingly, a high proportion of family planning method users in the younger age groups (15 to 29 years) prefer using traditional methods of contraception - 73% (15 – 19 years), 41% (20 – 24 years) and 20% (25-29 years)