India's Changing Contraceptive Scenario: A Brief Overview

India's Changing Contraceptive Scenario: A Brief Overview

Sushanta K. Banerjee, Samina Parveen, Sumit Gulati

The National Family Health Survey (NFHS), conducted every five years in India (with an exception in the gap between NFHS-3 and 4), has been instrumental in generating comprehensive information on various health and development indicators. Initiated in 1992-93, the surveys provide crucial information for policy decisions and assist program implementers in establishing benchmarks and monitoring progress over time in India's health sector.

Over the past three decades (NFHS-1: 1992-93 to NFHS-5: 2019-21), the use of modern contraceptive methods (measured by modern contraceptive prevalence rate, or mCPR) has increased by 55%, while the total fertility rate (TFR) has declined by 41%. In NFHS-5, we observe that most states and union territories have fertility rates below the replacement level (TFR 2.1), while the remaining four states – Meghalaya, Bihar, Uttar Pradesh, and Jharkhand – are transitioning towards replacement level TFR.

Historically, India has been over-reliant on permanent methods of contraception, particularly female sterilization. However, this trend changed significantly over time as the contribution of permanent methods to mCPR declined from 85% to 68% during NFHS-1 & NFHS-5, while the contribution of modern reversible contraceptive methods doubled during the same time. In addition, the unmet need for family planning declined from 20% to 9% and the gap between actual fertility and desired fertility also reduced over time. This reflects positively on the efforts made by government of India’s family planning program in offering basket of choices and increasing access for contraception. This new dynamic in family planning has impacted the momentum of the fertility transition in India.

Informed choice is a key indicator in monitoring delivery of choice-based family planning services. Over time this indicator has evolved and has been incorporated in NFHS (as shown in Fig 1) – demonstrating the vigorous nature of these surveys and the gradual progression of the indicators with time.

Figure 1: Evolution of the Informed Choice Indicator in NFHS

The trend of informed choice has improved significantly over the years. According to data from NFHS-2 and NFHS-5, the percentage of women using sterilization, pills, intra-uterine devices (IUDs), or post-partum IUDs (PPIUDs) who were informed about other methods increased from 14.7% to 69%. Additionally, NFHS-5 revealed that 62% of women who accepted any method were educated about potential side effects, and 54% were provided information on follow-up actions in case of complications. Although these gradual changes are encouraging, there is still a long way to go in further improving and ensuring comprehensive informed choice in family planning.

Throughout the NFHS surveys conducted from NFHS-1 to NFHS-5, the public sector has consistently played a dominant role as the primary source of contraception, particularly in rural areas. However, there has been an observed improvement in the involvement of the private sector over time, increasing from 15% to 25% for modern family planning methods. On the other hand, the contribution of retail shops in providing modern contraceptive services has remained relatively stable over the three-decade period, ranging from 6% to 7%.

These findings shed light on the dynamic and evolving landscape of family planning in India. The trends observed are marked by a notable increase in the utilization of modern contraceptives, a significant decrease in dependence on permanent methods, and an encouraging improvement in women's informed choice. This indicates that the efforts made by the government have been effective and improved over time in creating demand, expanding access, and providing choice-based services. However, these are overall numbers for the country, and it is crucial to acknowledge the regional variations that exist in the domain of family planning. This emphasizes the need for a comprehensive examination from the perspective of different population segments. Such context relevant insights will contribute to a more nuanced understanding of the evolving family planning scenario in India and help tailor interventions to address specific regional needs.

The authors are part of the Research and Evaluation team at Ipas Development Foundation. For more information, please write to idf@ipas.org