Pattern and correlates of out-of-pocket payment (OOP) on female sterilization in India, 1990–2014

Abstract

Background: Large scale public investment in family welfare programme has made female sterilization a free service in public health centers in India. Besides, it also provides financial compensation to acceptors. Despite these interventions, the use of contraception from private health centers has increased over time, across states and socioeconomic groups in India. Though many studies have examined trends, patterns, and determinants of female sterilization services, studies on out-of-pocket payment (OOP) and compensations on sterilisation are limited in India. This paper examines the trends and variations in out-of-pocket payment (OOP) and compensations associated with female sterilization in India. Methods: Data from the National Family Health Survey-4, 2015-16 was used for the analyses. A composite variable based on compensation received and amount paid by users was computed and categorized into four distinct groups. Multivariate analyses were used to understand the significant predictors of OOP of female sterilization. Results: Public health centers continued to be the major providers of female sterilization services; nearly 77.8% had availed themselves of free sterilization and 61.6% had received compensation for female sterilization. About two-fifths of the women in the economically well-off state like Kerala and one-third of the women in a poor state like Bihar had paid but did not receive any compensation for female sterilization. The OOP on female sterilization varies from 70 to 79% across India. The OOP on female sterilization was significantly higher among the educated and women belonging to the higher wealth quintile linking OOP to ability to pay for better quality of care. Conclusion: Public sector investment in family planning is required to provide free or subsidized provision of family welfare services, especially to women from a poor household. Improving the quality of female sterilization services in public health centers and rationalizing the compensation may extend the reach of family planning services in India.

Factors explaining the dominion status of female sterilization in India over the past two decades (1992-2016): A multilevel study

“…However, the result also confirmed the high level use of traditional methods among educated women. This result was surprising although there are many other studies support this fact [17,23]. A study also showed that one of the greatest factors supporting traditional contraception use among more educated and wealthier women was not the perceived ineffectiveness of modern methods but their wholesome side effects [33].…”

“…The reason for low prevalence of sterilization and high utilization of temporary methods by Muslim women can be explained by the religious doctrine of Islam which does not favors permanent methods of family planning [29][30][31]. The longstanding heterogeneity of population of India associated with religion and the caste system is still relevant in contraceptive choices [15][16][17]23,32,33].…”

“…Despite the clear distinction in effectiveness between modern and traditional contraceptive methods, a significant number of Indian women still use traditional family planning methods. Several myths about temporary methods of modern contraception restricts many women from accepting short-term reversible methods of contraception and opting for sterilization [ 6 , 17 ]. A number of studies have documented the over emphasis of female sterilization in family welfare programs, poor quality of care and limited choice of methods in both the high and low fertility states [ 14 , 15 , 17 ].…”

“…Several myths about temporary methods of modern contraception restricts many women from accepting short-term reversible methods of contraception and opting for sterilization [ 6 , 17 ]. A number of studies have documented the over emphasis of female sterilization in family welfare programs, poor quality of care and limited choice of methods in both the high and low fertility states [ 14 , 15 , 17 ]. Inequalities in the provision of family planning and reproductive health information, especially women from poorer communities are disadvantaged in terms of better care and information [ 11 ].…”

Individual- and country-level correlates of female permanent contraception use in sub-Saharan Africa

“…In settings where FPC requires a high out-of-pocket payment, clients with low income may not be able to afford it. Even in countries where FPC services are free, clients may still incur high out-of-pocket expenditure [44]. In developing countries, FPC services are less likely to be available and accessible in rural areas [45].…”