Tapping the Untapped: Huge Potential to Increase Family Planning Users in India

Abstract

<div><p><em>India’s family planning programs have historically focused on limiting the number of children but in recent years focus has shifted from limiting births to increased spacing between children, especially among young couples on contraceptive acceptance in the post-partum period. This paper examines the behavior of couples in India on acceptance of contraceptives during the postpartum period by using data from the National Family Health Survey-3 (NFHS-3, 2005-06) and from a small scale survey in state of Chhattisgarh in India. </em></p><p><em> </em></p><p><em>According to the data, approximately 75 percent of women with children under a year and 83 percent of women with children under six months’ old reported not using any contraception. Only 0.9 percent of postpartum women reported acceptance of intrauterine contraceptive devices. The primary reasons cited for not using contraception were breast feeding (27.5 percent) and postpartum amenorrhea (16.9 percent). Education and wealth index and program factor specially interaction with health workers during post-partum period and institutional delivery had a significant effect on acceptance of contraceptives during the postpartum period. Achieving one’s desired family size also positively influenced women’s acceptance of family size soon after delivery. Small scale survey in Chhattisgarh also suggested that acceptance of family planning to space children is not high.</em></p></div>

International seminar on promoting postpartum and post-abortion family planning: Challenges and opportunities

“…They conclude that counselling during pregnancy, counselling in the postpartum period with or without provision of immediate postpartum contraception, integration of family planning with immunization and child health services and broader community efforts can all be effective at raising contraceptive use in the months following childbirth, although the current evidence is least positive for antenatal interventions. Several other papers at the seminar also mirrored these observations (Agadjanian and Hayford, 2014;Alva et al, 2014;Paul et al, 2014;Wadhwa and Pillai, 2014;Zavier and Padmadas, 2014) With regard to strategies for improving post-abortion contraception, available evidence suggests that providing family planning counselling and services to women who seek abortion is encouraging (Cleland and Shah, 2014). Training health care providers in giving comprehensive abortion care and providing them long term post-training follow-up support as well as integrating structures to accommodate provision of both comprehensive or post abortion care and post-abortion family planning within the same structure can be effective (Banerjee et al, 2014;Antobam et al, 2014).…”

“…Evidence presented also indicates that postpartum sterilization is uncommon and wide inter-country variations exist in the proportion of sterilizations that are performed immediately or very soon after delivery, even in populations where it is the dominant method (Ali et al, 2014;Cleland and Shah, 2014). For example in India where female sterilization accounted for two-thirds of the total current contraceptive use in married women in general, 60% initiated postpartum contraception with methods other than female sterilization (Paul et al, 2014).…”

“…Several papers at the seminar explored the individual and health system-related correlates of postpartum and post-abortion contraceptive initiation, although the analytical approaches used in these studies were not typically able to establish a causal relationship. Better educated women were found to be more likely than their less educated or not educated counterparts to initiate postpartum contraception in India, urban slums in Nairobi and rural Mozambique (Paul et al, 2014;Mumah et al, 2014;Agadjanian and Hayford, 2014). In India, women from urban areas and economically better-off households were also more likely than others to have adopted postpartum contraception (Paul et al, 2014), so were socially connected women in rural Mozambique (Agadjanian and Hayford, 2014).…”

“…For example, Alva and colleagues in their analysis of five sub-Saharan African countries report that institutional delivery has a positive effect on uptake in the first year postpartum in all five countries, but child immunization was not universally associated with increased uptakeonly in three countries. In India too, women who sought antenatal services and institutional delivery were found to be more likely than others to have initiated use in the postpartum period (Paul et al, 2014;Zavier and Padmadas, 2014). Likewise, receiving family planning advice in the antenatal and perinatal periods was positively associated with early initiation of contraception, while patient flow at the facility was inversely associated with it in rural Mozambique (Agadjanian and Hayford, 2014).…”