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Decision making authority of woman, Husband and Family member's attitude towards family planning and Unmet need by Young Married Women in slums, UP, India
Source publication
Background:
NFHS-4 stated high unmet need for family planning (FP) among married women in Uttar Pradesh. Unmet need is highest among age groups: 15-19 and 20-24 years. Currently few data is available about unmet need for FP among vulnerable section of the community, i.e.15-24 year's age group living in the urban slums. Therefore this study was con...
Contexts in source publication
Context 2
... with husbands having a favorable attitude were found to be less likely to have an unmet need as compared to women whose husband had an unfavorable attitude (COR: 0.42, CI: 0.22-0.78) (Table 6). Also the unmet need was found to be more (66.9%) in absence of any discussion of family planning with husband and with others; the association being statistically insignificant. ...Context 3
... the other hand only 13.9% of the women who were motivated to use contraceptive methods had an unmet need. Unmet need was found to be less in those women who were motivated to use family planning methods by husbands, by other family members / friends / relatives, by health care providers but this association was found to be statistically insignificant (Table 6). About 11.6% young married women reported opposition to contraceptive use. ...Context 4
... 11.6% young married women reported opposition to contraceptive use. Women having opposition to contraceptive use were 5.00 times more likely to have an unmet need than women with no opposition and this association was found to be statistically significant (Table 6). ...Context 5
... having opposition to contraceptive use were significantly more likely to have an unmet need than women with no opposition (AOR: 7.36, CI: 1.3-40.7) ( Table 6). Women that had a contact with ANM were significantly less likely to have an unmet need than women who did not have a contact (AOR: 0.38, CI: 0.14-0.96) ...Citations
... Decision-making in such contexts is frequently dominated by men and influenced by social and environmental factors that can hinder women's ability to make decisions independently. 6,7 Multiple studies have suggested the strong impact that social, familial, cultural, and religious pressures can have in discouraging or encouraging the use of FP, [8][9][10][11][12][13][14][15][16] underscoring the importance of accounting for these influences when measuring contraceptive autonomy. However, the power of these multiple influences, and the overlap and interactions between them, have not been comprehensively incorporated in investigations of contraceptive autonomy. ...
Background
There is an increasing emphasis on promoting women’s autonomy in reproductive decision-making, particularly given global efforts to increase contraceptive access and uptake. Scales to quantify autonomy have inconsistently included the effect of external influences and focused primarily on influences of partners.
Objectives
This study aimed to gain greater depth in understanding how influences including and beyond a woman’s partner affect her contraceptive decision-making, as well as how external influences can overlap and further complicate contraceptive decision-making.
Design
A phenomenological, qualitative study in which in-depth interviews were conducted in three phases from May 2021 to February 2022 with women living in northwest Tanzania who had varying histories of contraceptive use or non-use.
Methods
One-on-one, in-depth interviews were conducted in Swahili, the national language of Tanzania, by trained female interviewers. Interviews were digitally recorded, transcribed, translated into English, and independently coded by three investigators. Analysis was conducted using NVivo. The codes developed from the transcripts were grouped into overarching themes with supporting illustrative quotes.
Results
A total of 72 women were interviewed. Partners were the most influential in women’s family planning decision-making, followed by friends, relatives, community religious leaders, and healthcare providers. Out of the 52 women with a partner who had ever used family planning, 76.9% had discussed their desire to use family planning with their partner and nearly all reported strong pressures to use or not to use family planning from partners, family, and friends. Rarely, participants stated that they were devoid of any influence.
Conclusion
In rural Tanzania, women’s decision-making about family planning was highly impacted by external influences, including not only partners but also family, friends, and community. Indicators of women’s reproductive autonomy and measurements of interventions to promote contraceptive use should incorporate measures of these external influences.
... Globally, demographic and socioeconomic characteristics such as age, place of residence, and education level have been shown as determinants of unmet need in studies focusing on specific developing nations [10,11]. Similar challenges have been identified in India, with a particular emphasis on subnational geographic variation [12]. India is a federation of 28 states and 8 UTs [13,14]. ...
... Despite these limitations, this study provides useful insights for policy deliberation. Prior studies have shown that unmet need for family planning is greatest among women of ages 15-19 years and those with the lowest education levels and belonging to the poorest households [12,39]. This study corroborates the claim that women of ages 15-19 years and those belonging to the poorest wealth quintile have the highest prevalence of unmet need, however, in 2021, women with the highest level of education had greater unmet need than women with lower levels of education. ...
Background
Eliminating unmet need for family planning by 2030 is a global priority for ensuring healthy lives and promoting well-being for all at all ages. We estimate the sub-national trends in prevalence of unmet need for family planning over 30 years in India and study differences based on socio-economic and demographic factors.
Methods
We used data from five National Family Health Surveys (NFHS) conducted between 1993 to 2021 for the 36 states/Union Territories (UTs) of India. The study population included women of ages 15–49 years who were married or in a union at the time of the survey. The outcome was unmet need for family planning which captures the prevalence of fecund and sexually active women not using contraception, who want to delay or limit childbearing. We calculated the standardized absolute change to estimate the change in prevalence on an annual basis across all states/UTs. We examined the patterning of prevalence of across demographic and socioeconomic characteristics and estimated the headcount of women with unmet need in 2021.
Results
The prevalence of unmet need in India decreased from 20·6% (95% CI: 20·1– 21·2%) in 1993, to 9·4% (95% CI: 9·3–9·6%) in 2021. Median unmet need prevalence across states/UTs decreased from 17·80% in 1993 to 8·95% in 2021. The north-eastern states of Meghalaya (26·9%, 95% CI: 25·3–28·6%) and Mizoram (18·9%, 95% CI: 17·2–20·6%), followed by the northern states of Bihar (13·6%, 95% CI: 13·1–14·1%) and Uttar Pradesh (12·9%, 95% CI: 12·5–13·2%), had the highest unmet need prevalence in 2021. As of 2021, the estimated number of women with an unmet need for family planning was 24,194,428. Uttar Pradesh, Bihar, Maharashtra, and West Bengal accounted for half of this headcount. Women of ages 15–19 and those belonging the poorest wealth quintile had a relatively high prevalence of unmet need in 2021.
Conclusions
The existing initiatives under the National Family Planning Programme should be strengthened, and new policies should be developed with a focus on states/UTs with high prevalence, to ensure unmet need for family planning is eliminated by 2030.
... The urban poor often have high fertility, low use of health services, poor maternal outcomes, and low contraceptive use. 11 FTPs in poor urban settings often face barriers to accessing quality reproductive health services because they are either overlooked by policies or are not reached by programs. 12 Since the launch of India's official FP program in 1952, its focus has been almost exclusively on permanent methods, such as male and female sterilization, with an overarching aim of controlling population growth. ...
Introduction:
Young newly married women and first-time parents (FTPs), particularly those living in slum settlements, have a high unmet need for modern contraceptive methods to limit and space births. We describe an intervention in which adolescents and youth sexual and reproductive health (AYSRH) services tailored to FTPs were incorporated into the government's existing family planning (FP) program in 5 cities of Uttar Pradesh. We examined the effect of this intervention on modern contraceptive use among FTPs aged 15-24 years.
Methods:
To assess the effect of this pilot, in 2019, 1 year after the implementation of the program, we analyzed community-based output tracking survey data on 549 married women who are FTPs in the pilot cities. These FTPs were compared with 253 women who were FTPs from other cities where the program was implemented without a specific focus on FTPs. Descriptive statistics and multivariate logistic regression analysis were applied to understand the association between exposure to FP information, either through accredited social health activists or through service delivery points, and use of modern contraceptives.
Results:
Use of modern contraceptives was higher among FTPs in the 5 pilot cities than non-pilot cities (39% vs. 32%; P<.05). The interaction effect of city type and exposure to the information showed a positive association between modern contraceptive use and program exposure, greater in pilot cities than non-pilot cities.
Conclusions:
Higher uptake of modern contraceptives among young women may be achieved when an FTP-focused intervention is layered on the government's existing FP programs. Future studies with a longer duration of implementation, in a wider geography, and with longitudinal design are recommended to provide more robust measures of high impact intervention/practices in urban areas.
... Also, the unmet need for family planning has been reported to be the highest among women who are younger than 20 years of age, and lowest among women aged 35 and older; these differences being found to be widest in South Central Asia, including India. Similar findings have also been reported in the studies done in South East Asia, South Africa and other developing nations of the world (Yadav, Agarwal, Shukla, Singh, & Singh, 2020). ...
Background: The number of poor families in Cibereum Sub-district is high compared to other sub- districts. Quoting data from Sukabumi City in Figures made by the Sukabumi City Central Bureau of Statistics, there are 3.798 poor families, 17.670 welfare I families and 73.543 welfare II families. Purpose: To determine the implementation of the family planning village program on the quality of life of the community in Cibeureum Subdistrict, Sukabumi City. Method: The research method used in this study is associative research using a quantitative approach. The population in this study were active family planning participants from the total Fertile Age Pairs with a sample size of 94 respondents. In this study, researchers used data collection techniques of observation, questionnaires / surveys, and literature studies. In this study using Likert scale measurements. The data analysis used was validity test, reliability test, correlation coefficient, coefficient of determination, regression analysis, and t test. Results: The results of this study showed that there was a positive and significant effect of the implementation of the family planning village program policy on the quality of life of the community in Cibeureum District, Sukabumi City. The more the implementation of the family planning village program policy increases, the quality of life of the community in Cibeureum District, Sukabumi City will also increase. Conclusion: From the results of the questionnaire distributed to the community as a whole is in the high category. The highest score is found in the statement regarding the effectiveness of the reporting and evaluation system for the Family Planning Village program implemented by related parties and the lowest total score is in the statement item regarding the ease of receiving information related to the Family Planning Village program from related parties.
... To find out the distribution of different contraceptive use among youth women (15)(16)(17)(18)(19)(20)(21)(22)(23)(24) years)in India To find out the state wise variation of different contraceptive use among youth women inIndia To identify the potential factors that influence the preference for modern contraception over traditional methods among young women in India ...
Book series on Medical Science gives the opportunity to students and doctors from all over the world to publish their research work in a set of Preclinical sciences, Internal medicine, Surgery and Public Health. This book series aim to inspire innovation and promote academic quality through outstanding publications of scientists and doctors. It also provides a premier interdisciplinary platform for researchers, practitioners, and educators to publish the most recent innovations, trends, and concerns as well as practical challenges encountered and solutions adopted in the fields of Medical Science.
... This has led to several health consequences including unplanned pregnancies (Sedgh et al., 2014) and high population growth explosions especially in the sub-Saharan African region (United Nations Department of Economic and Social Affairs Population Division, 2020). Different studies on unmet need have been done in several African countries like: Ghana (Pav & Boadi, 2000), Ethiopia (Dingeta et al., 2019), Nigeria (Mohammed et al., 2018), Cameroon (Edietah et al., 2018), Burundi (Nzokirishaka & Itua, 2018), Kenya (Ojakaa, 2008), Uganda (Khan et al., 2008(Khan et al., , pp. 1995(Khan et al., -2006 and other developing countries including, but not limited to, India (Prusty, 2014;Yadav et al., 2020), Afghanistan (Dadras et al., 2022) and Indonesia (Wilopo et al., 2017). A few studies exploring both individual and community factors associated with unmet need for contraception have been done in East Africa (Khan et al., 2008(Khan et al., , pp. 1995(Khan et al., -2006Nzokirishaka & Itua, 2018;Ojakaa, 2008). ...
Background
Despite the use of contraceptives being an expression of a woman's reproductive control, the prevalence of unmet need remains high and a public concern among married women in East Africa. However, limited literature has explored the associated factors in the region. We live in age of leaving no one behind unfortunately many women still have unmet for family planning todate. This study therefore intends to examine the individual and community level factors associated with unmet need for contraception among married women in Burundi, Rwanda, Tanzania and Uganda.
Methods
The study utilizes data from the four recent demographic and health surveys for Burundi, Rwanda, Tanzania and Uganda. Analyses were conducted using multilevel mixed effects logistic regressions with random community and country level effects. Results are reported using predictive probabilities and margins.
Results
This study revealed that: 20%, 22%, 28% and 33% of the married women in Tanzania, Uganda, Rwanda and Burundi respectively had unmet need for contraception. Younger women, and those: without formal education, from the poorest households, had ever experienced child loss, whose husbands desire more children than them, and have no access to family planning messages faced a higher probability of unmet need for contraception. This was also true for women living in communities with low usage of modern contraception and those in communities where there is an increasing number of children per woman.
Conclusions
The findings reiterate the need for family planning efforts to focus on younger women. Additionally, improved education, economic empowerment, calls for spousal involvement in family planning matters, support for those with child loss, and comprehensive awareness initiatives remain vital to tackling unmet need for contraception.
... Socioeconomic and demographic factors like age (15-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49), Residence (Urban, Rural), Religion (Hindu, Muslim, Christian, Sikh, Buddhist/Neo-Buddhist, Jain, Other), Caste/tribe (Scheduled caste, scheduled tribe, Other backward class, Other, don't know), Wealth quintile (Lowest, Second, Middle, Fourth, Highest), Sanitation Facility (yes/no), schooling (years of schooling), Child Marriage (yes/no), Birth Order (number of births), FP worker talked to a non-user (yes/no), ANC visits (number of ANC visits), Skilled birth attendant (yes/no), Urban Population (yes/ no), SC/ST Population (yes/no), Female Literacy (yes/no) were taken in the analysis. In the multilevel analysis, factors like age (15-29, 30-39, 40-49), Schooling (No schooling, up to 5 years, < 5 to 10 years, < 10 years), Religion (Hindu, Muslim, others), Caste (SC/ST, OBC, others), Children ever born (1, 2, 3, 4+), Place of delivery (public, private) were included based on past literature [19][20][21][22] . ...
Unmet needs for contraception in India have declined over time but the rate has not been uniform among women across geographies and socio-economic strata. Identifying the characteristics of women in communities where unmet need is still high is important to devise appropriate strategies to ensure access and uptake of modern contraceptive methods. The current study examined whether there was a national decline in unmet need over time and if regional disparities exist in unmet need. Demographic variations in unmet need based on factors such as maternal age, education, religion, caste, wealth index quintile, family size, and access to antenatal care (ANC) were also documented. Our approach was to document the prevalence of total unmet need for family planning and unmet need for spacing among married Indian women and quantify variability based on socio-economic and demographic drivers within a hierarchal framework, thus providing both macro and micro perspectives. We used data from the fourth and fifth rounds of the National Family Health Survey (NFHS) collected from all the States and Union Territories (UTs) in India. Quantile regression analysis and multilevel regression techniques were used to understand the predictors for the total unmet need for family planning and the unmet need for spacing. Results show a considerable decline in the prevalence of unmet need for family planning in India from NFHS-4 to 5 (from 12.9 to 9.3%) in the last six6 years. The north-eastern states show a significant reduction in unmet need for family planning in Manipur (17.8%), Nagaland (13.5%), and followed by Sikkim (9.1%). The predictors such as years of schooling, place of residence, caste, religion, wealth quintile, number of antenatal care (ANC) visits, and children ever born have a significant association with unmet needs for family planning and spacing among married women in India. There is a significant association between years of schooling with the total unmet needs for family planning at (q25) quantiles and the unmet need for spacing at (q25, q50) quantiles. Results reveal that the demand for unmet need for spacing and limiting was the highest among the women in the age categories 15–19 (17.8%) and 20–24 (17.3%). The demand for limiting was the highest (6.8%) among Muslim women. Across wealth quantile categories, the overall unmet demand (11.4%) for spacing and limiting was the highest among the women in the lowest socioeconomic groups. We conclude that greater access to frontline health workers among young wives, and significant investment in education in general, will continue to reduce the unmet needs for family planning in India.
... This campaign was integrated into all project social behaviour change communication interventions, including radio talk shows, social media and SMS messaging, and drama shows. Concerns about the side effects of contraceptives have been cited as one of the main barriers to the utilization of services by women, men, and young people both in Uganda [32][33][34] and elsewhere [35,36]. Contraceptive-related side effects not only inhibit the initial uptake of FP but are also lead to method switching and discontinuation [37]. ...
Voluntary, rights-based family planning upholds women’s right to determine freely the number and spacing of their children. However, low-resource settings like Uganda still face a high unmet need for family planning. And, while urban areas are often indicated to have better access to health services, emerging evidence is revealing intra-urban socio-economic differentials in family planning utilization. To address the barriers to contraceptive use in these settings, understanding community-specific challenges and involving them in tailored intervention design is crucial. This paper describes the use of co-design, a human-centred design tool, to develop context-specific interventions that promote voluntary family planning in urban settings in Eastern Uganda. A five-stage co-design approach was used: 1) Empathize: primary data was collected to understand the problem and people involved, 2) Define: findings were shared with 56 participants in a three-day in-person co-design workshop, including community members, family planning service providers and leaders, 3) Ideate: workshop participants generated potential solutions, 4) Prototype: participants prioritized prototypes, and 5) Testing: user feedback was sought about the prototypes. A package of ten interventions was developed. Five interventions targeted demand-side barriers to family planning uptake, four targeted supply-side barriers, and one addressed leadership and governance barriers. Involving a diverse group of co-creators provided varied experiences and expertise to develop the interventions. Participants expressed satisfaction with their involvement in finding solutions to challenges in their communities. However, power imbalances and language barriers were identified by the participants as potential barriers to positive group dynamics and discussion quality. To address them, participants were separated into groups, and medical terminologies were simplified during brainstorming sessions. These changes improved participation and maximized the contributions of all participants. It is therefore important to consider participant characteristics and their potential impact on the process, especially when engaging diverse participant groups, and implement measures to mitigate their effects.
... There are cross-country as well as within-country disparities, with lower levels of contraceptive use among poorer, illiterate, rural, and younger women [18]. Further these disparities are most pronounced in southern region of Asia, including India [19]. Studies show that in the Indian society many factors like urban vs rural residence, socioeconomic factors like household wealth and media exposure are likely to influence contraceptive use [11,18,20]. ...
... This study found existing differences in the non-usage of modern contraceptive methods among the young category and non-young category. In line with earlier research, our study reported that the usage of modern contraception was significantly associated with age and [19] it decreases with age [31,34,35]. This higher uptake among younger women has been attributed to effective communication on family planning issues [36]. ...
Abstract Background It is documented that married women do not utilize contraceptive methods, because of the fear of adverse effects, no or seldom sexual interaction; perception that they should not use contraception during breastfeeding, postpartum amenorrhea, or dissatisfaction with a specific method of contraception. The current study aimed to examine the socio-economic inequalities associated with the non-use of modern contraceptive methods among young (15-24 years) and non-young (25-49 years) married women and the contributing factors in those inequalities. Methods The present study utilized the cross-sectional data from the fourth round of the National Family Health Survey (NFHS-4) with a sample of 499,627 women who were currently married. The modern methods of family planning include sterilization, injectables, intrauterine devices (IUDs/PPIUDs), contraceptive pills, implants, the standard days method, condoms, diaphragm, foam/jelly, the lactational amenorrhea method, and emergency contraception. Multivariable logistic regression analysis was used to estimate the odds of non-use of modern contraceptive methods according to different age groups after controlling for various confounding factors. Additionally, concentration curve and Wagstaff decomposition method were used in the study. Results The prevalence of non-use of modern contraceptive use was higher among women from young category (79.0%) than non-young category (45.8%). The difference in prevalence was significant (33.2%; p
... Women of the younger age group (15-19 years) are more likely to have unwelcome habits because women of the 20-24 year age group are more likely and have more knowledge and understanding of contraception making them more mature, confident, and capable in making decisions consequently, resulting in less rent to have an Unmet need contraception. Research in developing countries found that women with less background knowledge and access to information will increase their knowledge in decisionmaking, they will consider decisions or hesitate against decisions in family planning (Yadav et al. 2020). ...
