Fertility and family planning in Uttar Pradesh, India: major progress and persistent gaps

Abstract

Background Uttar Pradesh (UP) is the most populous state in India with historically high levels of fertility rates than the national average. Though fertility levels in UP declined considerably in recent decades, the current level is well above the government’s target of 2.1. Data and methods Fertility and family planning data obtained from the different rounds of Sample Registration System (SRS) and the National Family Health Survey (NFHS). We analyzed fertility and family planning trends in India and UP, including differences in methods mix, using SRS (1971–2016) and NFHS (1992–2016). Bivariate and multivariate regression analyses were used. Results From 2000, while the total fertility rate (TFR) declined in UP, it is still well above the national level in 2015–16 (2.7 vs 2.18, respectively). The demand for family planning satisfied increased from 52 to 72% during 1998–99 to 2015–16 in UP, compared to an increase from 75 to 81% in India. Traditional methods play a much greater role in UP than in India (22 and 9% of the demand satisfied respectively), while use of sterilization was relatively low in UP when compared to the national averages (18.0 and 36.3% of current married women 15–49 years in UP and India, respectively in 2015–16). Within UP, district fertility ranged from 1.6 to 4.4, with higher fertility concentrated in districts with low female schooling, predominantly located in north-central UP. Fertility declines were largest in districts with high fertility in the late nineties (B = 7.33, p < .001). Among currently married women, use of traditional methods increased and accounted for almost one-third of users in 2015–16. Use of sterilization declined but remained the primary method (ranging from 33 to 41% of users in high and low fertility districts respectively) while condom use increased from 17 and 16% in 1998–99 to 23 and 25% in 2015–16 in low and high fertility districts respectively. Conclusions and implications Greater reliance on traditional methods and condoms coupled with relatively low demand for modern contraception suggest inadequate access to modern contraceptives, especially in district with high fertility rates. Family planning activities need to be appropriately scaled according to need and geography to ensure the achievement of state-level improvements in family planning programs and fertility outcomes.

Geographic and socioeconomic inequalities in the coverage of contraception in Uttar Pradesh, India

“…In one of the worst coverage divisions such as Basti, the demand met by modern contraception in urban areas is 60% compared to only 16% in rural areas. These above results are also corroborated by district level analysis of fertility decline by others [ 22 ]. The study has shown that the sterilization usage has increased substantially in very low and middle TFR clusters, while the contribution of the same method has declined, and traditional method has increased in high TFR cluster [ 22 ].…”

“…These above results are also corroborated by district level analysis of fertility decline by others [ 22 ]. The study has shown that the sterilization usage has increased substantially in very low and middle TFR clusters, while the contribution of the same method has declined, and traditional method has increased in high TFR cluster [ 22 ]. According to the study, it is due to lack of availability and accessibility of preferred method of choice.…”

“…In fact, one of the lowest demand satisfied divisions, Aligarh, is part of economically developed region, Western Uttar Pradesh [ 20 , 21 ]. Researchers have also shown that Jhansi division or Bundelkhand region has the lowest fertility rate in Uttar Pradesh [ 22 ]. It is difficult, if not impossible, to explain this anomaly in the absence of recent research.…”

“…It is not surprising that the sterilization uptake in Jhansi division is about 50% and same as in Madya Pradesh. Whereas in case of India it is about 35% but in case of UP it is about less than 18% [ 22 ]. Another contributing factor in this region could be, the smaller proportion of Muslim population, around 5% compared to more than 17% in UP.…”

Association between the place of abortion and post-abortion contraceptive adoption and continuation: the case of India

“…It has been established that reliance on traditional methods of contraception was associated with high failure rates which might result in subsequent unplanned pregnancies and abortions. 35 Using traditional methods put these women at risk of repeated abortions. Findings suggested a need for behavioural change among women towards adopting more effective Consistent with previous studies, education was found to have a positive relationship with the uptake of short-acting modern methods.…”