INTRODUCTION

. In India, the family planning program was implemented in 1952 as a national population policy to control the
rapid growth of population and reduce poverty .Initially, a number of modern methods were focused and later
shifted toward male sterilization, but female sterilization became the main focus from late 1970.The sterilization
targets, incentive-based administration, poor standards and forceful nature of the program created negative
impression among population and political confrontation in the country. Until the mid-1990s, almost all
reproductive and child health programs focused exclusively on women in India. In 1998, an informed choice
model of service delivery was introduced and currently, such a model without any targets or incentives is
implemented in the country

The utilization of contraceptive methods among Indian women is related to several factors such as personal,
interpersonal, partner related, service related and/or method related. The limited choices and access to family
planning services, poor quality of available services, cultural and religious opposition, fear of adverse effects
and gender-based barriers are responsible for the very high rate of unmet need for contraception in low-resource
countries such as India.1

Fertility is one of the most important elements in population dynamics that has signifcant contribution
towards changing population size and structure over time. On the other way, family planning is the
right of individuals and couples to freely and responsibly decide the number and spacing of their
children and to have the information, education and means to do so. International health experts now believe
that the healthiest interval between a woman’s previous birth and her new pregnancy is at least two years
and by preventing closely spaced births, family planning could save the lives of more than 2 million infants
and children annually.

Th e reproductive behavior of women in a given community can be a selected by factors like: age at entry
into marriage, access to family planning services, ability to utilize these services, economic status of the
household and cultural and traditional norms in which the woman lives. According to Caldwell et al. and
Bongaart et al., high fertility in traditional African societies is associated with the economic benefits that
children provide to their parents In addition, it is shown that fertility rate is the highest in sub-Saharan Africa
than any parts of the world, mainly due to strong kinship and high economic and social Fertility is one
of the most important elements in population dynamics that has significant contribution towards
changing population size and structure over time.

On the other way, family planning is the right of individuals and couples to freely and responsibly
decide the number and spacing of their children and to have the information, education and means to do so.
International health experts now believe that the healthiest interval between a woman’s previous birth
and her new pregnancy is at least two years and by preventing closely spaced births, family planning could
save the lives of more than 2 million infants and children annually reproductive behavior of women in a
given community can be a selected by factors like: age at entry into marriage, access to family planning
services, ability to utilize these services, economic status of the household and cultural and traditional
norms in which the woman lives. According to Caldwell et al. and Bongaart et al., high fertility in traditional
1
African societies is associated with the economic benefits that children provide to their parents. In addition,
it is shown that fertility rate is the highest in sub-Saharan Africa than any parts of the world, mainly due to
strong kinship and high economic and social Fertility is one of the most important elements in population
dynamics that has significant contribution towards changing population size and structure over time. On the
other way, family planning is the right of individuals and couples to freely and responsibly decide the number
and spacing of their children and to have the information, education and means to do so. International health
experts now believe that the healthiest interval between a woman’s previous birth and her new pregnancy is at
least two years and by preventing closely spaced births, family planning could save the lives of more than 2
million infants and children annually.

The reproductive behavior of women in a given community can be affected by factors like: age at entry into
marriage, access to family planning services, ability to utilize these services, economic status of the household
and cultural and traditional norms in which the woman lives.2.

Millions of women worldwide would prefer to avoid becoming pregnant either right away or never get
pregnant, but are not using any contraception. These women are said to have an “unmet need” for family
planning. The concept of unmet need points to the gap between some women's reproductive intentions and their
contraceptive behavior. Unmet need can be a powerful concept for Family Planning programs because it is
based on the women's own statement in answer to survey questions, and it identifies the group most likely to be
interested in contraception, but who do not use it. The challenge is for family planning to reach and serve these
women.

In Bangladesh, an estimated three in five married women currently use a method of contraception. The country
experienced an impressive sevenfold increase in its contraceptive prevalence rate in less than forty years, from
8% in 1975 to 62% in 2014. The Contraceptive Prevelance Rate plays a significant role in assessing the
demographic impact of family planning programs However, it is imperative to recognize that fertility is not
solely dependent on the prevalence of contraceptive use but also on contraceptive use-effectiveness and user
adherence . Married women in the country are having 0.7 more children than they desire, meaning that the total
fertility rate would be 30% lower if unplanned pregnancies were avoided. While this may also be explained by
unmet need for family planning, which is equally important to explore the effectiveness of family planning
programs in addressing issues related to contraceptive method use3.

In low- and middle-income countries, women’s beliefs about specific contraceptive methods are not well
understood. This study documents the beliefs about eight contraceptive methods among women living in Matlab
(rural Bangladesh), Nairobi slums and Homa-Bay (rural Kenya) and compares the opinions of current, past and
never users of the most commonly used methods (oral contraceptives, injectables and implants). In each site, we
interviewed 2424 to 2812 married women aged 15–39 years. As expected, we found that current contraceptive
users were typically satisfied and had more positive beliefs about their method than past or never users.
Nevertheless, large minorities of current users thought that their method might cause serious health problems,
impair future childbearing and was unsafe to use for a long time; higher proportions (25–50%) reported that
their method use caused unpleasant side effects. Past users of pills and injectables outnumbered current users
and their beliefs were similar to never users. In all three sites, about half of past injectable users reported
satisfaction with the method but the satisfaction of past implant users was lower. Despite high contraceptive use
in these populations, adverse and inaccurate beliefs about the major methods persist, particularly in Kenya. The
generally negative views of past users imply that programmes may need not only to improve individual
2
counselling but also strengthen community information campaign to change the overall climate of opinion
which may have been influenced by dissatisfaction among past users.4

The concern with contraceptive use among the currently married adolescents in Bangladesh, 1989 analyzed the
factors affecting the current use of contraception among the adolescents through bivariate and multivariate
logistic regression analysis. The results indicate that although adolescents have almost universal knowledge
about contraceptive methods, only 15 percent are currently using any method of contraception. The
corresponding figures for the adults and for the nation as a whole are 34.4 percent and 31.4 percent,
respectively. Among the individual methods currently used by the adolescents, the pill appears as the most
popular method, followed by safe period. A substantial proportion of the adolescents were found to rely on the
traditional methods of contraception. Among the socio-economic variables respondents' education, participation
in the family planning decision, visit by family planning workers, region of residence, husband's occupation and
possession of electricity in the household appear as the most significant factors determining the current use of
contraception among the adolescents.5

Family planning is a highly cost-effective means to achieve Sustainable Development Goals as it provides a
number of benefits for the investment made. Voluntary family planning can bring a variety of transformational
benefits to women, families, communities, and countries (Realizing this potential, Family Planning 2020 a
global partnership, was formed to work toward empowering women and girls, by investing in right-based family
planning; and expanding access to information, services, and supplies to those who want to have control on
whether, when, and how many children they would have .

As a commitment to 2020, the Government of India is working toward expanding the range and reach of
contraceptive options at all levels, enhancing its supply chain system, and increasing awareness and generating
demand for family planning services . However, in spite of all these efforts, estimates showed that the
prevalence of contraceptive use in India did not increase much in the last five years—from 52% in 2014 to 54%
in 2019 .6

Family planning policies in India have historically been aimed at controlling population growth rather than
advancing women's reproductive rights and choices . This led to an explicit promotion of sterilization, targeted
nearly exclusively towards women. Government policy has since changed, as laid out in the 2014 Family
Planning 2020 action plan , which still promotes sterilization with monetary compensation (both for individuals
undergoing the procedure and for the health providers) but also includes reversible modern contraception
methods. At this time, three new contraceptive methods were introduced in the National Family Planning
program—injectable contraceptive, a non-hormonal weekly pill and progesterone-only pills for lactating
mothers—all provided free-of cost. Intrauterine device remains low despite being covered under public health
services for decades and condom use only increased subsequent to HIV prevention efforts in the country.
However, despite these changes in the policy environment, the use of reversible contraceptive methods, as well
as male sterilization, is still low in India, and female sterilization continues to be the dominant method,
accounting for two-thirds of the total contraceptive use .

In this paper, we evaluated the coverage with modern methods in India and the share of each type of
contraception (long-acting reversible, short-acting reversible and permanent methods) being used. Additionally,

3
we assessed inequalities in these indicators according to women's age, education, wealth, subnational region of
residence and empowerment level.7

NEEDFOR THE STUDY

The topic of this study was to assess the use of contraceptives and family size prefernces among women of
reproductive age in slected community areas of noida .In this study,I sought to determine the The long acting
and permanent contraceptive methods has not used unlike that of short-acting methods. The generally negative
views of past users imply that programmes may need not only to improve individual counselling but also
strengthen community information campaign to change the overall climate of opinion which may have been
influenced by dissatisfaction among past users.8

Family size preferences are concentrated in small family sizes, slightly higher for rural women and women with
4 years' education, but with group averages ranging from 2.3 (urban women currently married 5 years with 4
years' education) to 3.4 (all currently married rural women educated 4 years). A comparison between the
Buddhist majority and Moslem minority reveals that contraceptive use is lower and fertility levels and
preferences higher among Moslems than among Buddhists. Contraception practice by region, racial/language
group, work status; % having undesired pregnancies by rural and urban residency; source of supply
(government or private); and method are also examined.9

As of 2012, modern contraceptive use remains low. Only 7% of married women and 23% of unmarried sexually
active women use modern methods.Unmet need has increased since 2006, from 27% to 33% among married
women and from 35% to 50% among sexually active unmarried women. Among married women with unmet
need, the most commonly cited reasons for contraceptive nonuse are fear of side effects/health concerns (22%)
and opposition to use (22%). In contrast, never-married women with unmet need cite not being married (42%),
infrequent or no sex (21%) and fear of side effects/health concerns (17%). Among women currently using
sterilization, IUDs, implants, injectables or the pill, 57% report having been told about side effects when they
received their method; 88% of those who were told about side effects were given instructions on how to deal
with them.Strategies to increase contraceptive use include improving the availability and quality of
contraceptive services, increasing knowledge of family planning, and addressing social and cultural barriers to
contraception.

The importance of targeting young, low-parity couples for family planning services cannot be overemphasized.
Women 15-24 years old make up 44% of all women of reproductive age. Also, there are large cohorts of girls
just below reproductive age that will soon begin having children. Recent studies show a surprisingly high
demand for contraception among younger couples. A complete registration of eligible couples in each
fieldworker's area must be completed. Fieldworker and supervisor training must be adapted to focus on this
target group. The provision of maternal-child health services becomes increasingly important as more young
couples are brought into the program. Temporary birth control methods should make up a larger proportion of
the country's method-mix target. The current family planning media campaign should highlight the health
4
benefits for mother and child of family planning used for spacing. The government should continue to promote
the small family norm. More effort should be made to influence community and religious leaders and men in
general. Immunization and other child survival activities should be intensified.10

Urban women as expected had higher rates of knowledge. 16.5% of women reported they wanted no more
children, 33% wanted a child in less than 2 years, 32.4% wanted to wait at least 2 years, and 9.3% wanted a
child at some undetermined future date. Women not wanting more children were as numerous in rural as in
urban areas and were evenly distributed in all regions of Mali. Ethnic differences were found in the desire to
terminate childbearing. Illiterate women wanted fewer children than those with primary educations, but those
with secondary or higher educations wanted much smaller families. Although around 16% of women in rural as
well as urban areas wanted no more children, only 4% of urban and 2% of rural women wanting no more
children stated they intended to use contraception. 58-65% of women in various regions expressed a need for
contraception for spacing births, but very low percentages actually intended to use a method. Social pressures
from a profoundly pronatalist society appear to hinder actual use of contraception. 2.3% of rural women and
11.6% of urban women use modern contraception. The contraceptive user in Mali tends to be an educated urban
woman who wishes to space births that are already numerous.11

Ensuring universal access to sexual and reproductive health and reproductive rights for all women is of the
Sustainable Development Goals, promoted by the United Nations and adopted by 193 countries. To address
women’s need for family planning, the provision of a wide range of safe, effective and affordable contraceptive
methods is essential . It is also important to note that every contraceptive method has advantages and
disadvantages . Thus, it is essential that women are fully informed about them so they can make an informed
decision on which method is more appropriate for their specific situation. A nationally representative study
found that India's demand for family planning satisfied with modern contraceptive methods was 70% in 2005,
with heavy reliance on female sterilization rather than reversible contraceptive methods . These findings already
suggested the need for greater focus on improving access to reversible methods, especially for women who wish
to delay or space pregnancies but are not ready to commit to ending their fertility. 12

STATEMENT OF THEPROBLEM

A cross sectional study to asess contraceptive use and family size prefernces among married women of
reproductive age in selected community area of noida

OBJECTIVES

To assess the contraceptive use among married women of reproductive age in seleted area of noida
5
To assess the family size prefernces among married women of reproductive age in selected area of greater noida

ASSUMPTION

Items in the questionnaire will be adequate to assess the knowledge regarding contraceptive uses among married
women of reproductive age

Women will respond honestly to the questionnaire employed for data collection.

Women will participate in the study honestly and information will be provided by the women which closely
reflect their knowledge and level towards uses of contraceptives methods

OPERATIONAL DEFINITIONS

ASSESS - In this study assess the contraceptive use and family size prefernces among married women of
reproductive age

CONTRACEPTION - Contraception is the act of preventing pregnancy. This can be a device, a medication, a
procedure or a behavior. Contraception allows a woman control of her reproductive health and affords the
woman the ability to be an active participant in her family planning.

FAMILY- A family is a group of two or more persons related by birth, marriage, or adoption who live together;
all such related persons are considered as members of one family.

FAMILY SIZE PREFRENCES - Family size preference refers to a measure of a person's preferred family
size .opined that family size preference otherwise known as family size desires are the number of children
wanted in one's lifetime..

6
MARRIAGE - marriage, a legally and socially sanctioned union, usually between a man and a woman, that is
regulated by laws, rules, customs, beliefs, and attitudes that prescribe the rights and duties of the partners and
accords status to their offspring .

WOMEN -Female human being; a person assigned a female sex at birth, or a person who defines herself as a
woman.

WOMEN OF REPRODUCTIVE AGE - De facto population of women of reproductive age (15-49 years) in a
country, area or region as of 1 July of the year indicated.

DELIMITATION OF THE STUDY

Delimitations refer to the specific boundaries that are set in a research study in order to narrow its scope and
focus. Delimitations may be related to avariety of factors, including the population being studied, the
geographical location, the time period, the research design, and the methods or tools being used to collect data.

This study is delimited to:

Women of reproductive age in rural area of noida

Women belong to reproductive age group (15-49)

7
SIGNIFICANCEOF THE STUDY

The significance of studying contraceptive use and family size preferences among married women lies in its
profound implications for public health, social development, and individual well-being. Here are several key
points illustrating the significance of such research:

Population Dynamics: Understanding contraceptive use and family size preferences provides insights into
population dynamics. It helps policymakers anticipate future demographic trends, such as population growth
rates, age structure, and dependency ratios. This knowledge is crucial for planning healthcare, education, and
social welfare systems.

Maternal and Child Health: Effective contraceptive use can reduce maternal and infant mortality rates by
enabling women to space their pregnancies and plan their families. Family planning allows women to avoid
unintended pregnancies, which may be associated with higher risks of maternal complications and adverse birth
outcomes.

Women's Empowerment: Access to contraception empowers women to make informed decisions about their
reproductive health and overall life choices. It can enhance women's educational and economic opportunities by
enabling them to pursue higher education, participate in the workforce, and invest in their careers.

Poverty Alleviation: Family planning can contribute to poverty reduction by allowing families to invest more
resources in each child's health, education, and well-being. Smaller family sizes may also alleviate financial
strain on households, leading to improved living standards and economic stability.

Environmental Sustainability: Population growth can exacerbate environmental challenges, such as

deforestation, resource depletion, and greenhouse gas emissions. By helping to control population growth,
family planning initiatives can support sustainable development goals and mitigate environmental degradation.

Healthcare Systems: Understanding contraceptive preferences and usage patterns can inform the design and
delivery of healthcare services, including family planning programs. It enables healthcare providers to tailor
their services to meet the specific needs of different populations, thereby improving access to reproductive
healthcare services.

8
Gender Equality: Promoting contraceptive use and respecting women's reproductive rights are essential
components of gender equality efforts. Ensuring women's autonomy over their bodies and reproductive choices
is fundamental to achieving gender equity and combating discrimination and gender-based violence.

Cultural and Societal Norms: Research on contraceptive use and family size preferences can shed light on
cultural and societal norms surrounding reproductive health and family planning. This understanding is essential
for developing culturally sensitive and effective interventions that address barriers to contraceptive access and
utilization.

CONCEPTUAL FRAMEWORK

REVIEW OF LITERATURE

A study to assess contraceptive use and family size prefernces among married women of reproductive age

Fauzia Akhter Huda et al (2014)1 conducted a study on contraceptive use among married women of
reproductive age . There has been a decline in the use of long acting and permanent methods over the last two
decades. Within 12 months of initiation, the rate of method discontinuation particularly the short-acting
methods remain high at 36%. It is important to recognize the trends as married Bangladeshi women, on average,
wanted 1.6 children, but the rate of actual children was 2.3. Findings showed that method discontinuation and
switching, method failure, and method mix may offset achievements in the CPR. Most of the women know of at
least one contraceptive method. Oral pill is the most widely used (27%) method, followed by injectables
(12.4%), condoms (6.4%), female sterilization (4.6%), male sterilization (1.2%), implants (1.7%), and IUDs
(0.6%). A renewed commitment from government bodies and independent organizations is needed to implement
and monitor family planning strategies in order to ensure the adherence to and provision of the most appropriate
contraceptive method for couples.

S M Mostafa Kamal et al (2007)2 a study to assess the socioeconomic factors and childbearing and
contraceptive use among married female adolescents. The current contraceptive prevalence rate was 42%. The
multivariate logistic regression yielded a significantly increased risk of childbearing among adolescents with no
formal education, those who were married-off before age 16, the poor and those who had ever used any
contraceptive method. Inter-spousal communication on family planning appeared as the most single significant
determinant of any contraceptive use. Number of living children, working status and visitations by family
planning workers are also important determinants of contraceptive use amon Early childbearing, lower use rate
of contraceptive methods and unintended pregnancies are common among married adolescents in Bangladesh.
Expanded schooling and reproductive health programmes in Bangladesh should promote increased
communication about FP within the couples in order to achieve successful contraception and better reproductive
outcomes, particularly among adolescents. Overall, 69% of the married adolescents initiated childbearing and
25% of the most recent pregnancies were unintended.
9
A Chamratrithirong, P Kamnuansilpa, J Knodel et al (2016)3 conducted a study to check Prevalence among
currently married women has continued to increase from 53% in 1978 to 65% in 1984; approaching rates
common in developed countries. The Contraceptive Prevalence Survey in Thailand was conducted in 1984,
sampling 7,576 ever-married women aged 15-49. It was based on a weighted sample scheme, interviewing
approximately equal numbers in each of the 4 major regions and in Bangkok, including the same 24 provinces
as in the previous CPS-2, and a supplementary population of southern Moslems. Female sterilization is the most
common method (23.5% of all married women) although a range of other methods is also seen (pill, 19.8%,
injectables, 7.6%; IUD, 4.9%, male steralization, 4.4%; condom, 1.8%; and other, 2.6%). Low levels of unmet
need for contraception for either limiting family size or spacing children now exist. National total fertility rates
had fallen since the previous survey (from 3.68 in 1981 to 3.36 in 1984), but to a lesser extent than would be
expected from the increased contraceptive use. Family size preferences are concentrated in small family sizes,
slightly higher for rural women and women with 4 years' education, but with group averages ranging from 2.3
(urban women currently married 5 years with 4 years' education) to 3.4 (all currently married rural women
educated 4 years).

10
Ahmed Zohirul Islam et al (2011)4 conducted a study to assess The unmet need for contraception
was 17% and contraceptive prevalence was 54% in this young group. The results suggest that
region, place of residence, religion, husband's desire for children, visits of FP workers, decision-
making power on child health care, reading about FP in newspaper/magazine and number of
births in three years preceding the survey were significant predictors of unmet need for
contraception. Total demand for contraception was 71% and the proportion of demand satisfied
was 77%. The study found that unmet need for contraception among currently married, fecund
women under 25 years old is higher than the national level, and hence different or more intensive
programme initiatives are required for them than for older women. The present study identifies
important predictors of unmet need for contraception among fecund married Bangladeshi women
under age 25.

Arnab K Dey et al (2016)5This study contributes to existing research on the relationship between
sex composition of children with ideal family size preferences and contraceptive use by
highlighting meaningful differences between higher and lower parity couples. Findings from the
study can be used by family planning programs in India to customize family planning
counselling messages by both sex composition and parity. Findings suggest that couples with
four or more children are more likely to use modern contraceptives when they have at least one
son and one daughter and are less likely to use contraceptives when they have all daughters and
no sons, than couples who have no daughters. Our findings indicate that the sex composition of
children is associated with men's higher ideal family size preference, relative to women, among
couples with four or more children. We also find that couples with less than four children are less
likely to use modern contraceptives when they have an equal or a greater number of daughters
than sons compared to those who have no daughters.

Jissa Vinoda Thulaseedharan et al (2015 )6 conducted a study to assess the contraceptive use and
family size preferences among average age at marriage for women was 21.3 years, and 23% of
women had more than one child. A considerable number of females in the age group 25-28-years
opting for sterilization and the unique preference for female sterilization when the family size is
complete show the predominant reliance on female sterilization among young women. Higher
education delays sterilization in young women due to delayed marriage and childbirth. Women
empowerment, proper information and assuring availability and accessibility to different
methods can gradually change the dominant preference for female-oriented permanent method of
contraception. Current use of any contraceptive methods was 58%. Female sterilization was
preferred by 13% and it was significantly higher among women aged 25-28 years than in those
aged 18-24 years (20% vs 2.6%, p<0.001). Female sterilization was significantly lower among
women with higher levels of education than in women with an education level of plus two or
below (5.8% vs 19%, p=0.006). Women were mostly in favor of female sterilization (91%), and
a significantly lower proportion of highly educated women preferred female sterilization than
women with an education of 12 years or below (85% vs 95.7%, p=0.008).

11
Vasanthakumar Namasivayam et al (2023 )7 conducted a study to Community and facility
platforms can also be engaged in providing modern method choices to women of other parities to
increase modern contraceptive use further to achieve the SDG goals. The results show that while
the modern method use has increased by 2.2 percentage points, the TM use increased by 9.9
percentage points compared to NFHS-4 (2015-16). The use of TM was almost same across
women of different socio-demographic characteristics. Of 2921 current TM users, 80.7% started
with TM and 78.3% expressed to continue with the same in future. No side effects (56.9%), easy
to use (41.7%) and no cost incurred (38.0%) were the main reasons for the continuation of
TM. Initial contraceptive method was found to have significant implications for current
contraceptive method choice and future preferences. Program should reach young and zero-
parity women with modern method choices by leveraging front-line workers in rural UP.

Corey J A Bradshaw et al (2023)8 conducted a study to assess the potential associations between
the availability and quality of family planning and fertility, Overall, there is more that can be
done to aid in meeting the initiatives of the Sustainable Development Goals of the United
Nations, which, if unmet, will see global increases in fertility, more child deaths, and more birth-
related deaths among women. Fertility was Normally distributed (Shapiro-Wilk normality
test: W = 0.970; p = 0.123) with one outlier (Niger), although that country’s value of 7.14 per
woman is the highest national fertility globally [25]. A non-parametric (Kendall’s τ) correlation
matrix of the highest-ranked variable from each initial model (S1 Table) indicated that the
strongest correlation observed was the relationship between access to any form of contraception
and household size (τ = -0.516). Of all regions, countries in sub-Saharan Africa had the highest
average number of infant mortalities (45 per 1000 live births), as well as the highest average
fertility (4.8 per woman) .

Kiranmayee Muralidhar et al (2024)9 conducted a study to assess poor knowledge and utilization
of temporary contraceptive methods among a tribal population in rural Mysore, India.
Interventions aiming to increase knowledge of contraceptive options are important for birth
spacing in this population and should target younger women and those without contact with
government health facilities. There was widespread knowledge about female sterilization, while
only 39.3% of women reported hearing about one or more forms of temporary contraception, and
36.3% knew where to get them. The largest proportion of women had heard about copper-T
(33.0%), followed by oral contraceptive pills (23.8%), condoms (11.9%), and injectables (4.6%).
Only 2.7% of women reported ever using any form of temporary contraception. Results from the
multivariable logistic regression indicated that knowledge of at least one form of temporary
contraception was linked to higher age (adjusted odds ratio[AOR]: 1.09; 95% CI: 1.02, 1.17),
greater number of years of marriage (AOR: 0.90; 95% CI: 0.85, 0.96), and last birth in a
government facility (AOR: 3.67; 95% CI: 1.99, 6.82).

Aswathy Sreedevi et al (2022)10 conducted a study to assess Awareness and use of contraceptives
are poor though the fertility is not commensurately high. Along with developing targeted
responses to contraceptive use among Indigenous people with indigenous data, awareness also

12
requires attention. The mean age of the study participants was 30.8 years (SD=9.8) and belonged
to various tribal groups such as Paniya (59.2%), Kurichiyar (13.6%) and Adiya (10.9%). Current
use of contraceptive was reported by about a fourth, 658 (26.4%) (95% CI 27.9 to 24.9) of
women. Following logistic regression, belonging to Paniya tribe (adjusted OR (aOR) 2.67, 95%
CI 1.49 to 4.77; p<0.001) and age at menarche >13 years (aOR 1.69, 95% CI 1.14 to 2.52;
p<0.009) had significantly higher use of contraceptives whereas social vulnerability as indicated
by staying in a kutcha house had a lesser likelihood of use of contraceptive (aOR 0.55, 95% CI
0.31 to 0.95; p<0.03). Oral contraceptive use was low (4.8%) among this population and no
abuse was observed.Less than half (47%) of the respondents had an above average knowledge on
contraception. Multivariable logistic regression indicated that above average knowledge was 2.2
times more likely with higher education (95% CI 1.2 to 3.9), lesser among those who desired
more than two children (aOR 0.59; 95% CI 0.38 to 0.94; p<0.02).Two children per family was
the preferred choice for 1060 (42.5%) women. No gender bias in favour of the male child was
observed.

Deborah Bateson et al ( 2013)11 conducted a study to assess Women and GPs differed in their
ranking of contraceptive characteristics. Long duration of use, high efficacy, minimal or no
bleeding without pain, were preferred by both. Very undesirable were heavy periods especially
with pain, and low efficacy. Two hundred women, mean age 36, 71% using contraception, were
presented with descriptions of 16 possible methods and asked to indicate their preference for
individual characteristics. One hundred and sixty-two GPs, mostly women, also completed 16
descriptions. Longer duration of action was most favoured by both, followed by lighter periods
with less pain or amenorrhoea. The least attractive features for women were heavier and more
painful periods, high cost, irregular periods, low efficacy (10% failure) and weight gain of 3 kg.
GPs ranked a 10% pregnancy rate as least attractive followed by heavy painful periods and a 5%
failure rate.

J F Phillips et al (1996)12 conducted a study to assess the long-term rationale for household
family planning in Bangladesh-where growing use of contraceptives, rapid fertility decline, and
normative change in reproductive preferences are in progress, bringing into question the
rationale for large-scale deployment of paid outreach workers. Results of the analysis indicate
that 1) outreach generates incremental contraceptive use that would not arise if underlying
demand were the sole determinant of use; 2) the outreach activities of male workers have no role
in maintaining use; 3) outreach continues to foster contraceptive use because of the high
frequency of encounters; 4) the outreach program is the single most important component of
program exposure in the study population; 5) outreach generates a small but significant demand
for contraception; and 6) sex preferences for offspring are weakened, but not eliminated, by
outreach. These results suggest that the outreach program should be continued and that the male
health assistant role should be revised or phased-out. Without outreach, contraceptive prevalence
would be 15 points lower than the observed level of 40%. Even though outreach has a continuing
demographic role, this role should be reevaluated periodically, especially to determine how to

13
employ supporting communication strategies. These findings may also be extrapolated to similar
settings in other countries.

Patrick Asuming et al (2019)13 conducted a study to assess atent demand for family planning and
therefore if family planning programs are appropriately implemented they can yield the desired
impact. The prevalence of contraceptive use was low at 13%, while unmet need is highly
pervasive and demand for family planning is predominantly for spacing future childbearing
rather than for the purpose of stopping. Overall, about 31.7%of women not using contraceptives
reported a need for spacing while 17.6% expressed a need for limiting. Thus, the latent demand
for family planning is dominated by preferences for space rather than limiting childbearing.

Walter Forrest et al (2018)14 conducted a study to assess the results imply that violence enables
some men to resolve disagreements over the use of contraception by imposing their fertility
preferences on their partners. They also indicate that unmet need for contraception could be an
intended consequence of violence. the evidence that violence consistently constrains
contraceptive use is inconclusive. One plausible explanation for this ambiguity is that the effects
of violence on contraceptive use depend on whether couples are likely to have conflicting
attitudes to it. In particular, although some men may engage in violence to prevent their partners
from using contraception, they are only likely to do so if they have reason to oppose its use.
Using a longitudinal follow-up to the Indian National Family Health Survey (NFHS-2),
conducted among a sample of rural, married women of childbearing age, this study investigated
whether the relationship between IPV and contraceptive use is contingent on whether women’s
contraceptive intentions contradict men’s fertility preferences. Results indicate that women
experiencing IPV are less likely to undergo sterilization, but only if they intended to use
contraception and their partners wanted more children (Average Marginal Effect (AME)=−0.06;
CI=−0.10, −0.01). Violence had no effect on sterilization among women who did not plan to use
contraception (AME=−0.02; CI=−0.06, 0.03) or whose spouses did not want more children
(AME=−0.01; CI=−0.9, 0.06).

14