According to data from the latest National Family Health Survey (NFHS-4), India has seen a decline in the use of contraceptives in 10 out of 14 states surveyed. That’s a 6 percent drop, over 10 years, in the use of what are considered “modern methods” among women considered of childbearing age (15-49), according to IndiaSpend. This drop comes even as awareness about contraceptives has grown (according to NFHS-4, Andhra Pradesh has the highest level of awareness about condom use among women, 86.3 percent). So what can we learn about contraceptive use across India, and what might be behind this mismatch between theory and practice?
“Traditional” vs “modern” methods aren’t in a life-and-death struggle
Let’s start by looking at what we mean by “modern” methods: it includes female and male sterilisation, the contraceptive pill, intra-uterine device (IUD), post-partum IUD (PPIUD, used after childbirth), injectables, male and female condoms, and emergency contraception. “Traditional” methods refer to periodic abstinence — also known as the “rhythm” method: not having sex when the woman is likely to be ovulating — and withdrawal (aka the pull-out method). With the exception of condoms, none of the methods above provide protection from sexually transmitted disease. And “traditional” methods don’t necessarily always have a high rate of failure, or mean that those relying on them are uneducated or ignorant. (For an exploration of the fascinating complexities behind this, read Alaka Malwade Basu’s 2001 paper on the use of “traditional” methods among upper class women.)
Data on contraception across states varies rather widely, and isn’t always what you would expect
NFHS-4 tells us some interesting stuff about contraceptive use in the states surveyed (although the Ministry of Health and Family Welfare cautions us that the figures from this survey may not strictly be comparable to previous rounds of the NFHS due to differences in sample size.) In Karnataka, which has a high prevalence of HIV, while 50 percent of women were aware that consistent condom use would reduce the chance of HIV/AIDS, only 1.3 percent reported using condoms. The most widely used method by far (to which condoms came in second) was female sterilisation at 48.6 percent. Overall, across rural and urban areas, 51.3 percent of women reported using any modern method of contraception. A decade ago, this figure stood at 62.5 percent. In Goa, where 37.2 percent of women used modern methods a decade ago, only 24.8 do now (female sterilisation accounts for 16.3 percent of this) — the sharpest decline of all states. In Manipur, condom use had the most drastic drop, from 4.1 percent a decade ago to 1.3 percent. In six of the 14 states surveyed, the use of IUDs had risen.
Clearly, not all of this data corresponds with what we might anticipate. Tamil Nadu has a high rate of contraceptive use, but where 60 percent of women used “modern” methods in 2005-2006, this figure is now 52.6 percent. NB Sarojini,ounder and director of the Sama Resource Group for Women and Health, working on issues of women’s health and rights, says, that in Tamil Nadu, “Female sterilisation rate is very high, education levels and health facilities are also better, so one would think that Tamil Nadu may be doing much better, but such is not the case and that is very surprising.”
People may be not be using contraceptives as much, but they aren’t having more children
“One good thing,” says B Paswan, “is that although family planning has gone down, TFR [Total Fertility Rate: the number of children born per woman of child-bearing age] has not increased. It has gone down too.” Paswan is Professor and Head, Department of Population Policies & Programmes at the International Institute for Population Sciences, the designated nodal agency responsible for providing coordination and technical guidance for the survey. Interestingly, data on the states that were surveyed under the NFHS-3 as well show that the TFR dropped in all 14 of them. Goa has the lowest TFR: 1.7, down from 1.8, while Bihar has the highest: 3.4, down from 4 in 2005-2006.
Paswan thinks one reason for lower contraceptive use might be because people are getting married later. The median age of marriage among Indians according to WHO and Ministry for Health and Family Welfare in India- 2011 report is 22.2 for men and 26 for womenas compared to 20.2 for men and 24.8 for women in 2001. By his reasoning, the need for contraceptive use starts later among individuals.
Excuse me, but only married women are surveyed on contraceptive use
Sarojini points out that the NFHS does not take into account statistics on unmarried women. If late marriage is one of the contributing factors to this decline, it brings along with it more questions: is everyone who marries late also abstaining from sex until then? If we take the sanskaari route and assume that we don’t need to collect data on pre-marital sex, will we ever get a clear picture on contraceptive use in India?
The rate of female sterilisation has (thankfully) dropped
Dr Sreeparna Chattopadhyay, Assistant Professor at the School of Development, Azim Premji University, says that NFHS-4 data shows a decline in the practice of female sterilisation as contraception. She sees this as a good thing, and says it needs to be cross-referred with women’s age at marriage for a clearer picture of whether other kinds of contraception have taken its place, such as “traditional” methods. Chattopadhyay also points out that the drop in contraception use should also be weighed against whether the number of abortions has increased.
Sarojini further says that it is important to note that the use of contraceptives and family planning always falls on the woman’s shoulders, men are never equal participants in it. She says, “Either women who need family planning methods are not accessing the services or services are not reaching out to them with the methods that they want. We need to take a serious look at the service provisioning and address critical gaps in the quality and reach of these services,” she says.
Co-published with Firstpost.