Women's use of contraception in rural India:: a village-level study
Introduction
India officially gained the title of the world's second population ‘billionaire’ on the 11th of May, 2000. As the country's population continues to swell, there is mounting apprehension that unbridled growth will negate any economic gains made in the years following independence. The Indian government is persistent in its efforts to decrease fertility and promotes family planning by offering free contraception through local health services and monetary incentives for sterilization. Although the use of modern contraception is reportedly on the rise in rural India, figures for contraceptive use are still relatively low. As nearly 75% of India's population still lives in villages (Census of India, 1991a), there is a strong push to increase the acceptance of birth control in non-urban settings. Both men and women have been variously targeted for birth control, but especially in the last two decades, women have been the primary targets.
In this paper, I investigate the willingness of low-income women living in the rural area of Kultali in Eastern India to use locally available birth control offered through the family planning component of the Family Welfare Program. I examine factors that inhibit or promote their use of family planning and the implications of this for policy. I hypothesize that the availability of government-sponsored health care services and their quality as perceived and experienced by village women is associated with use of birth control.
Section snippets
Family planning in India
India was the first country in the world to adopt an official family planning program and family planning has always been a component of the country's population policy. However, success in reducing fertility has been sporadic and dogged by controversy. Following independence in 1947, the official policy regarding birth control during the First and Second plan periods (1951–1961), was to provide contraceptive services to couples desiring to space or limit births. Initially, the emphasis was on
Conceptual background
Factors known to affect contraceptive use extend from the attributes of the individual, through resources of the household and community in which (s)he lives, to socio-cultural mores and institutions that affect autonomy, behavior and lifestyle, and access to health care services.
These factors are complex and inter-related. For example, women's status has been linked to their use of contraceptives and thus their fertility (Dyson and Moore, 1983; Fort, 1989; Jejeebhoy, 1991). Among the
The study area
The villages from which the sample for the study was selected are located in the Kultali Thana (administrative units also known as Blocks, into which districts are divided) of the South 24-Parganas district in the state of West Bengal in Eastern India (Fig. 1). Within India, West Bengal ranks fairly high in terms of socio-economic indicators and is considered to be a progressive state based on its demographic characteristics. The state had a literacy rate of 57.7% compared to 52.1% for India in
Contraceptive prevalence
Family planning at the government's health centers in Kultali continues to be an important aspect of the family welfare program. The use of various methods of contraception at the Block level for the years 1991–1995 is presented in Table 1.
It is clear that female sterilization is the most popular method of contraception in the Block. It is the only method with high and consistent use over the period. This is partly because this method of birth control has traditionally been promoted by the
Conclusion
In the study area, the major factors that influence contraceptive use among married women in their reproductive years are the woman's age, the number of sons she has, her religion and village of residence. The findings of the study and their policy implications are summarized in Table 6.
Most of the women interviewed stated that they would like to limit the size of their families. However, family planning is not always practiced. The tendency to postpone the use of contraception until the couple
Acknowledgements
I am grateful to Tom Foggin for his support and constructive comments on earlier drafts of this paper. Thanks also to the anonymous reviewers, whose suggestions were very helpful; to Ivan Cheung for the map, and Michael Hayes for his encouragement.
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