Migration and family planning in the state with highest total fertility rate in India

Abstract

Background This study examined the relationship between male out-migration and family planning (FP) behaviour of women in rural Bihar. Methods Data was collected from 937 currently married women aged 15–34 years from two districts of Bihar, namely Nawada and Gopalganj. Respondents were selected through a multi-stage systematic sampling and were recruited from both low and high male out-migration blocks. Differences in FP outcomes—use of modern contraceptive methods, intention to use contraceptives in next 12 months and access to FP services—were assessed by volume of migration, husband’s migration status, frequency of return, and duration of husband’s stay at home during visits. Results Women with migrant husbands were about 50% less likely to use modern contraceptive methods. Further, the odds of using modern contraceptives was about half among women with migrant husbands if they resided in high out-migration areas (HMA) than low out-migration areas (LMA) (15% vs 29%, AOR: 0·50, p = 0·017). A higher proportion of women with migrant husbands, specifically from HMA, reported greater intention of using contraceptives in next 12 months than their counterparts (37% vs 23%, AOR: 1·83, p = 0·015). Similarly, access to FP services was negatively associated with the volume of male out-migration, specifically for women with migrant husbands. Conclusions The migratory environment as well as the migration of husbands affect contraceptive use and access to FP services among women. Given that a significant proportion of married males leave their home states for work, it is imperative that FP programs in migration affected areas plan and implement migration-centric FP implementation strategies.

Husband’s migration status and contraceptive behaviors of women: evidence from Middle-Ganga Plain of India

“…Their husband’s migration act as a natural method of contraception. Undoubtedly, because of the social circumstances that exist in rural communities, women may feel internally stigmatized to access family planning procedures in the absence of the husband [ 5 , 9 ]. On the other side, the main reason for not using contraceptives among the non-migrant wives was the desire for children.…”

“…But male out migration is an important factor in Middle-Ganga plain that influenced the contraceptive behavior of women. This study found that left behind wives are less likely to use the any of the contraceptive methods than the non-migrants wives; this might be the reason for the preference for a male child, absence of interspousal communication, and poor outreaches of local ASHA workers [ 5 , 9 ]. A study conducted in Pakistan shows that, due to a lack of communication between spouses over family planning, most were unaware of their partner's preference for family size and contraceptive use [ 31 ].…”

“…The previous studies shows that, male out-migration is negatively associated with reproductive health services and contraception in developing countries [ 5 , 8 ]. A study conducted in Bihar suggests that male out-migration is one of the most significant factors that could have influenced the prevalence of modern contraceptives [ 9 ]. According to a study conducted in Nepal, women with migrant husbands were less likely to use contraception and have access to family planning services while having greater autonomy than those women staying together with their husbands [ 10 ].…”

A prospective cohort study to assess the acceptability of Sayana Press among 18–49-year-old women in Nepal

“…Nepal and elsewhere has also shown that women with migrant husbands feel internally stigmatized and were less likely to access FP methods in the absence of husband [16][17] due to existing social contexts [16]. Further, national trends in injection use appear to be decreasing likely due to COVID-19 restrictions [18].…”

Intermittent Needs for Family Planning among Women with an Internal Migrant Husband in Bangladesh: A Qualitative Study

“… 24 , 25 In Southern Mozambique women married to migrants had a lower birth rate 26 and men’s out-migration has been associated with reduced contraceptive use in multiple studies elsewhere in South Asia. 21 , 27–29 Much of the existing empirical evidence we have on the fertility-related behaviours of women married to men who migrate come from a context defined by long-term, international migration.…”