1. 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. 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.
3. 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. 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
6. 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
9. 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. 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
11. 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. 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.
13. 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. 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
