Among young married women in India, the demand for contraception to delay first pregnancy is high but largely unmet.1 According to a study conducted in six states, 51% of women aged 15–24 who had been married for five or fewer years had delayed or wanted to delay their first pregnancy; of those, only 10% had used a modern or traditional form of contraception. Contraception was more likely to be practiced by women with eight or more years of education than by women with no education (odds ratios, 2.0–3.2), and less likely to be practiced by women who felt pressure to become pregnant soon after marriage than by those who did not feel such pressure (0.6).
Cultural norms in India discourage contraceptive use early in marriage; as a result, little is known about the demand for contraception during this period, including the extent to which the demand is satisfied and the characteristics associated with having the demand. To fill this gap in the literature, researchers analyzed data from a survey conducted in 2006–2008 among women in Andhra Pradesh, Maharashtra and Tamil Nadu, all of which are located in the country’s relatively developed southern and western region, and in Bihar, Jharkhand and Rajasthan, which are situated in the less-developed northern and eastern region. The states were chosen to represent the country’s social, economic and demographic diversity. Women who had been married for more than five years, were not cohabiting with their husband at the time of the interview or had not answered the survey question about whether they wanted to delay their first pregnancy were excluded from the final sample.
Participants were asked if they had wanted a baby as soon as possible after marriage. Those responding “no” were considered to have had a demand for contraception. The respondents were then asked if they had used any modern or traditional contraceptive method to delay their first pregnancy; if they had, they were considered to have had a satisfied demand for contraception. The remainder of the survey included questions on women’s social and demographic characteristics; premarital knowledge of contraception; relationship characteristics and early marital experiences; and perceived access to health care. The researchers conducted multivariate logistic regression analyses, both for the sample as a whole and by region, to identify characteristics associated with contraceptive use among women with a demand for contraception to delay first pregnancy.
Overall, 51% of the 9,572 women in the sample had had a demand for contraception to delay first pregnancy; this proportion was higher in the northern and eastern region than in the southern and western region (62% vs. 44%). Among these women, 10% had used contraceptives; the proportion was similar in both regions. In general, condoms were the most common contraceptive used by those with a demand for contraception (65%), followed by oral contraceptives (27%) and traditional methods (16%); however, a higher proportion in the southern and western region than in the northern and eastern region reported use of the pill (39% vs. 14%), while the reverse was true for the use of traditional methods (10% vs. 23%).
For almost all of the variables examined, women with a demand for contraceptives differed from their counterparts who had wanted a pregnancy as soon as possible. Compared with other women, those with a demand for contraceptives were better educated, and they were more likely to have been aware of and known how to get contraceptives before marriage (23% vs. 16%), to report first marital sex as forced (28% vs. 22%), to have decision-making power in everyday matters (29% vs. 23%), and to be comfortable approaching a health care professional for contraceptives (56% vs. 51%). Also, compared with other women, those with demand were less likely to have been 18 or older at cohabitation (48% vs. 54%), to have worked before marriage (29% vs. 35%), to be an urban resident (24% vs. 26%), to have been involved in choosing their husband and to have known their husband before marriage (29% vs. 37%), and to have felt pressure to become pregnant quickly (26% vs. 37%).
Regional differences in the profiles of young women with a demand for contraception followed expected patterns. Compared with their counterparts in the less-developed northern and eastern region, young women in the southern and western region were more likely to have been 18 or older at cohabitation (61% vs. 35%), to be better educated, to have worked before marriage (35% vs. 23%), to have received quality sex education (16% vs. 1%), to have a husband five or more years older (66% vs. 50%), to have been involved in choosing their husband and to have known their husband before marriage (48% vs. 11%), to report having decision-making power in everyday matters (32% vs. 25%) and to report self-efficacy in expressing their opinions to elders or in confronting others (23% vs. 13%). Also, women in the southern and western region had a higher mean household wealth.
In multivariate logistic regression analyses among the 4,933 women with a demand for contraception to delay first pregnancy, a variety of characteristics were associated with contraceptive use, sometimes with regional variations. Overall and across regions, better education was positively associated with contraceptive use to delay first pregnancy (odds ratios, 2.0–5.3), as were household wealth (1.03–1.05 per additional scale unit), premarital awareness of contraceptives and where to obtain them (1.4–1.9) and having received quality sex education (1.5–2.5); having felt pressure to get pregnant soon after marriage was negatively associated with satisfied demand (0.5–0.7). Involvement in choosing a husband was associated with contraceptive use overall (1.8) and in the southern and western region (2.0), but not in the northern and eastern region. Similarly, having discussed marital issues (how to spend money, problems with in-laws and when to have a baby) early in marriage was associated with satisfied demand overall and in the southern and western region (1.3 and 1.4, respectively), but not in the northern and eastern region. Women’s decision-making authority was associated with contraceptive use to delay first pregnancy overall (1.7) and in the northern and eastern region (2.3), but not in the southern and western region. Comfort approaching health care workers was associated with increased odds of satisfied demand in the southern and western region (1.4); forced first marital sex was negatively associated with contraceptive use in the northern and eastern region (0.7).
The researchers note several study limitations: They could not assess duration or consistency of contraceptive use; the data were cross-sectional; the agency and access to health care variables reflected the respondents’ current situation, rather than their situation shortly before or after marriage; the agency variable may not have reflected the various ways women may be able to exercise choice; and the health care access variable was hypothetical and not based on the respondents’ actual experiences. Despite these limitations, the researchers conclude that their study “provides compelling evidence countering the popular notion that young couples in India do not wish to delay childbearing and underscores the limited exercise of reproductive rights displayed by many recently married young women.” —L. Melhado
1. Jejeebhoy SJ, Santhya KG and Francis Zavier AJ, Demand for contraception to delay first pregnancy among young married women in India, Studies in Family Planning, 2014, 45(2):183–201.