Trends and Determinants of Unmet Need for Family Planning in Bihar (India): Evidence from National Family Health Surveys

doi:10.4236/aasoci.2013.32021

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Advances in Applied Sociology

2013. Vol.3, No.2, 157-163

Published Online June 2013 in SciRes (http://www.scirp.org/journal/aasoci) http://dx.doi.org/10.4236/aasoci.2013.32021

Trends and Determinants of Unmet Need for Family Planning in

Bihar (India): Evidence from National Family Health Surveys

Amit Kumar1, Aditya Singh2

1International Institute for Population Sciences, Mumbai, India

2School of Health Sciences and Social Work, University of Portsmouth, Portsm outh, UK

Email: [email protected]

Received January 22nd, 2013; revised Februa ry 24th, 2013; accepted March 2nd, 2013

Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium,

provided the original work is properly cited.

Using data from all three rounds of the National Family Health Survey, this study examines the trends and

determinants of unmet need for family planning in the state of Bihar. Bivariate analysis was carried out to

examine the level and trends of unmet need for family. Binary logistic regression was used to examine the

factor affecting unmet need for family planning. About 25% of the currently married women, aged 15 - 49

years, in Bihar at present have an unmet need for family planning services, 11% for spacing and 12% for

limiting. Only 18% of total demand for spacing methods is met compared to about 72% of total demand

for limiting methods. The unmet need for family planning among Muslim (32%), rural (24%) and adoles-

cent (36%) and poor women (26%) is relatively higher than other groups. “Religious prohibition” and

“husband opposed” were the main reasons for not using contraception. A considerable proportion of older

women (45 - 49 years) and those living in urban areas cited method-related reasons. About 86% of Mus-

lim women cited opposition to use as the main reason for not using family planning. The same is also sub-

stantiated by logistic regression analysis where the odds of unmet need were significantly higher among

Muslim women (OR = 1.88; p < 0.05). Women from Other Backward Castes (OR = 0.74; p = 0.05) and

rich households (OR = 0.55; p = 0.00) had lower odds of unmet need for family planning. The results

highlight the need of an effective implementation of information, education and communication activities

in the communities and improvement in the quality of advice and care services related to family planning.

Family planning policies and programs in Bihar should focus on reaching out to the women from disad-

vantaged groups such as adolescent, Muslim, poor and Scheduled Caste.

Keywords: Family Planning; Unmet Need; Fertility; Bihar; National Family Health Survey

Introduction

The world fertility has been declining steadily since 1950s

with major contributions from the declines that took place in

China and India (Wilson, 2001). India, being the second largest

country in the world in terms of population, was worried about

it population growth in the wake of mortality decline and sub-

sequent rise in life expectancy in the post-independence period

(Visaria & Chari, 1998). This led to the implantation of the

first-ever official family planning program in the world by the

Government of India in 1952. The result was obvious in the

form of the beginning of fertility decline in India in the first

half of 1960s. However, some northern and central Indian states

such as Uttar Pradesh, Bihar, Rajasthan and Madhya Pradesh

could not be the part of the process until 1980. In fact, their

current total fertility rates are still relatively very high (Guil-

moto & Rajan, 2004; Balabdaoui et al., 2001). High fertility

levels not only have several adverse implications for societies

but also for individuals. Since these states constitute a great

chunk of India’s population, they are the major players that

would determine future socioeconomic and demographic situa-

tion of the country. Hence, quick and substantial reduction in

fertility in low resource settings, such as these states, is a highly

desirable goal.

What works best for achieving maximum reduction in fertil-

ity is still a much-debated issue. However, previous studies

conducted in different settings around the world have estab-

lished the fact that contraception is one of the most important

proximate determinants of fertility (Sibanda et al., 2003; Karki

& Krishna, 2008; Bongaarts et al., 1984). Similarly, several

studies in India too have examined the fertility decline and the

factors catalysing such decline in India and its states (Visaria,

1999; Bhattacharya et al., 1995; Pathak et al., 1998; Aroki-

asamy, 2009; Jain A. K. & Jain A., 2010). It is well established

now that increased contraceptive use explains much, but not all,

of the recent fertility decline in India and its states as well.

Family planning being a viable solution to control such fast

growing populations, not only helps in spacing and limiting the

number of children, but also improves maternal and child health,

empowers women and boosts economic development. However,

a large proportion of women from reproductive ages who want

to stop or space childbearing are unable to use family planning

methods. Demographers and health specialists refer to these

women as having an “unmet need” for family planning. Limited

access to family planning results in high rates of unintended

pregnancies, millions of unsafe abortions and thousands of

A. KUMAR, A. SINGH

maternal deaths (Bradley et al., 2012). The unmet need for fam-

ily planning is defined as the proportion of married women of

reproductive age who are not using any method but would like

to postpone the next pregnancy i.e. unmet need for spacing or

who do not want any more children i.e. unmet need for limiting

(Westoff, 1988). Thus, unmet need for family planning is a

discrepancy between expressed fertility goals and contraceptive

practice.

Many studies in the past in India and elsewhere have found

that women with unmet need for family planning constitute a

significant fraction of all married women of reproductive age

(Bradley et al., 2012; Ojakaa, 2008; Pasha et al., 2001). Ac-

cording to an estimate, more than 100 million sexually active

women in developing countries would like to adopt family

planning but they are not able to. Asia, owing to its huge popu-

lation, is by far the region with the greatest number of women

with unmet need of contraception. Kishore (2007) estimated

that India has about 31 million of women with unmet need for

family planning (Kishore, 2007), despite the existence of the

National Policy on Family Planning since the year 1983.

Bihar is the focus of this study for several reasons. It is the

third most populated state of India with approximately 9%

(about 10 billion as of 2011) of the total population. It is the

poorest state of the country, with the exception of Orissa, and

ranked among the slowest growing regions of the country until

recently. High maternal and child mortality, low life expectancy,

high fertility, high unmet need for contraception, low literacy

rate, low coverage of child immunization and high child mal-

nutrition (ORGI, 2012; IIPS & ORC Macro, 2007). Among

four high fertility states mentioned above, Bihar is the one that

has shown a near stall in fertility decline in the post-1997 pe-

riod. The low rate of contraceptive use and high level of fertil-

ity in Bihar are of considerable concern to the Indian Govern-

ment, which has launched innovations in family planning ser-

vices project intended to increase contraceptive use in the state.

According to NFHS-III (2005-2006), about 24% of currently

married women in Bihar have unmet need for family planning,

which is comparatively much higher than that of India as a

whole (IIPS & ORC Macro, 2007). Unfortunately, a very little

research has focused on systematic documentation of unmet

need for family planning in the state. A comprehensive study of

unmet need in the state is highly desirable in order to develop a

locally relevant and suitable strategy to overcome the problems

of unmet need on priority basis. Hence, this study aims to ex-

amine the trends and determinants of unmet need for family

planning in the state of Bihar.

Data and Methods

Data

We use data from all three rounds of the National Family

Health Survey (NFHS), a nationally representative survey, car-

ried out during 1992-1993, 1998-1999 and 2005-2006. The

main purpose of the survey is to provide reliable estimate of

fertility, infant and childhood mortality, nutritional status of

children, utilization of maternal and child health care services,

at national level, state level and separately for urban and rural

area. All three rounds of the survey adopted multi-stage sam-

pling design—two stage sampling design in rural areas and

three-stage in urban areas. The sampling design remained simi-

lar in all the three rounds of the surveys, which allow a com-

parison with the estimates of the consecutive rounds. The de-

tails of sampling design and sample size estimation are pro-

vided in the reports of the various rounds of the NFHS (IIPS &

ORC Macro, 1995, 2000, 2007).

The NFHS collected data using different interview schedules

—household schedule and eligible women/individual schedule.

The content of the interview schedules remained similar in all

the three rounds of the survey. In Bihar, the survey collected

information from 4659 women in first round (NFHS-I con-

ducted in 1992-1993), 5410 women in second round (NFHS-II

1998-1999) and 3818 women in third round (NFHS-III con-

ducted in 2005-2006). The household response rate was 99% in

the first round, 98 % and 99% each in the second and third

rounds of the survey. Similarly, the individual response rate was

95.5% and 94.7 % each in the first and second rounds, while it

was 97% in the third round of the survey.

Outcome Vari able

Our outcome variable is unmet need for family planning. We

have adopted our definition for this study from the NFHS-III

national report. The definition used in this study remains same

across the three rounds of NFHS survey. According to the re-

port, unmet need can be of two types—unmet need for spacing

and unmet need for limiting. The sum of the unmet need for

limiting and the unmet need for spacing is the total unmet need

for family planning. The total demand for family planning is

the sum of unmet need and met need (IIPS & ORC Macro,

2007).

Unmet need for spacing includes pregnant women whose

pregnancy was mistimed; amenorrhoeic women who are not

using family planning and whose last birth was mistimed, or

whose last births was unwanted but now say they want more

children; and fecund women who are neither pregnant nor

amenorrhoeic, who are not using any method of family plan-

ning, and say they want to wait two or more years for their next

birth. Also included in unmet need for spacing are fecund

women who are not using any method of family planning and

say they are unsure whether they want another child or who

want another child but are unsure when to have the birth (IIPS

& ORC Macro, 2007).

Unmet need for limiting refers to pregnant women whose

pregnancy was unwanted; amenorrhoeic women who are not

using family planning, whose last child was unwanted and who

did not want any more children; and fecund women who are

neither pregnant nor amenorrhoeic, who are not using any

method of family planning, and who want no more children.

Excluded from the unmet need categories are pregnant and

amenorrhoea women who became pregnant while using a

method (these women are in need of a better method of contra-

ception) (IIPS & ORC Macro, 2007).

Predictor Variables

We use a range of socio-demographic variables in the analy-

sis that have been found to be significantly associated with

unmet need for family planning in India and elsewhere. These

variables are—respondent’s age (five years of age-interval),

place of residence (urban; rural), religion (Hindu; Muslim;

Other), caste (Scheduled Caste—SC; Other Backward Castes—

OBC; Others), mother’s exposure to media (yes; no), current

working status of mother (yes; no), age at marriage in years

158

A. KUMAR, A. SINGH

(below 15; 15 - 16; 17 - 18; above 18), household structure

(nuclear; non-nuclear), number of living children (none; one;

two; three; four or more), standard of living (low; medium;

high), woman’s education (illiterate; primary ; secondary; high

school and above) and husband’s education (illiterate; primary ;

secondary; high school and above).

S tatistical Analysis

Bivariate analysis was carried out to examine the level and

trends in unmet need for family planning. Chi-square test was

used to examine the significant association between unmet need

for family planning and socioeconomic and demographic char-

acteristics of women. In the present study, unmet need for fam-

ily planning was a binary outcome (respondents with unmet

need were coded “1” and rest were coded “0”), therefore, the

binary logistic regression was used. The exposure variables

were tested for possible multi-collinearity using the means of

variance inflation factors (VIFs) as a post-estimation procedure

following the regression analysis. A small VIF (1.45) suggested

absence of any significant collinearity between explanatory

variables in the regression model. The regression analysis was

performed only on most recent dataset i.e. NFHS-3. The result

obtained from the regression analysis was presented in the form

of odds ratios with 95% confidence interval. The analyses were

carried out with the help of statistical software Stata 12 SE

(Stata, 2011).

Results

Level and Trends of Dem and and Unmet Need fo r

Family Planning

Ta b l e 1 shows the demand for family planning. About 48%

of all women in reproductive ages were in need of family plan-

ning in India in 1992-1993. However, it increased by 9 percent a ge

points to reach 56% in 2005 -2006. I t is noticeab le that the d emand

Table 1.

Level and trends in demand for family planning demand for family

planning in bihar, 1992-2006.

Year 1992-1993 1998-1999 2005-2006

Unmet need for family pl anning

For spacing 14.4 12.6 10.7

For limiting 10.6 11.9 12.1

Total 25.1 24.5 22.8

Met need for f amily planning

For spacing 1.9 1.4 2.2

For limiting 21.1 23.1 31.9

Total 23.1 24.5 34.1

Total demand for family p lanning

For spacing 16.4 14.0 12.9

For limiting 31.8 35.0 44.0

Total 48.1 49.1 56.9

Note: Computed for m NFHS data files.

for spacing has been decreasing over the period. Converse is

true about the demand of family planning for limiting. It in-

creased from 32% in 1992-1993 to 44% in 2005-2006. How-

ever, the increase in the demand of family planning for limiting

during 1999-2006 is thrice that of during 1993-1999. The level

of unmet need among women from reproductive ages in Bihar

was about 25%, which reduced to 23% in 2005-2006—a de-

cline of 2 percentage points in last 15 years. Looking separately

at unmet need for spacing and limiting, it comes to the fore that

the unmet demand for family planning for limiting purpose has

been increasing over time while same for spacing has been

declining steadily over the period.

Tabl e 2 also shows the unmet need for family planning by

background characteristics during all three rounds of NFHS. It

is interesting to see that adolescent women, who have lowest

demand for family planning in 2005-2006, have the greatest

unmet need for family planning (36%). The unmet need for

family planning has considerably increased in adolescent

women while, in most of the other age groups, the unmet need

among women has decreased. The unmet need among urban

women (17%) is considerably lower than among rural women

(24%) during 2005-2006. They also experience a greater reduc-

tion in unmet need for family planning during 1992-2006. Ex-

cept women with 10 years or more, the unmet need for family

planning among women belonging to other education catego-

ries varies very little.

The unmet need for family planning during 1998-2006 re-

mains more or less stagnant in these categories except women

with 10 or more years of schooling who experienced a reduc-

tion of about 6 percentage points. The unmet need for family

planning among Hindus (21%) is less than among Muslims

(32%) during 2005-2006. Muslims have witnessed a slight

increase in the unmet need while Hindus have experienced a

reduction of similar magnitude during 1992-2006. Women be-

longing to Scheduled Castes (SCs) show higher unmet need for

family planning than those belonging to Other Backward

Castes (OBCs) during 2005-2006. However, OBCs witness

slightly greater reduction in unmet need than SCs. Unmet need

is considerably higher among women with low standard of

living (26%) than among those with high standard of living

(14%) during 2005-2006. Reduction in unmet need during

1992-2006 is also highest among women with high standard of

living.

Main Reasons for Not Using Contraception

Table 3 presents main reasons for not using contraception for

spacing and limiting as told by respondents in NFHS-III

(2005-2006). About 38% women cited religious prohibition as

the main reason for not using contraceptive for spacing while

about 12% cited opposition from husband as the main reason.

Some (about 10%) also cited infrequent/no sex as the reason for

not using contraceptive for spacing. About 9% respondents did

not use contraceptive because they themselves opposed (9%) its

use. Many women (7%) did not use contraception for spacing

because they did not know any method of contraception (7%).

As far contraception for limiting purposes, religious prohibition

(25%) turns out to be the most cited reason behind not using

contraception. Apart from that, husband’s opposition (16%) and

respondent’s own opposition (10%) to use of any kind of mod-

ern contraception were among most cited reasons. About 9% of

women did not use contraception because they considered

A. KUMAR, A. SINGH

Table 2.

Proportion of currently married women having unmet need for family

planning by selected background characteristic in Bihar, 1992-2006.

Backgroun d characteristics Unmet need for family pl anning

NFHS-1 NFHS-2 NFHS-3

Respondent ’s age

15 - 19 26.6 31.4 35.5

20 - 24 35.2 33.0 28.2

25 - 29 28.7 30.6 29.6

30 - 34 25.7 27.8 20.4

35 - 39 21.6 16.4 14.6

40 - 44 13.4 9.3 11.1

45 - 49 4.5 3.1 5.4

Place of residence

Urban 20.4 23.1 16.7

Rural 25.9 24.7 23.8

Respondent ’s education

Illiterate 25.7 24.9 23.2

Primary 24.1 21.8 23.6

Secondary 20.7 25.9 24.5

High school a nd above 21.9 24.5 17.1

Religion

Hindu 24.2 23.8 21.2

Muslim 30.1 29.0 31.7

Caste

Scheduled c aste 29.2 27.2 25.9

Other bac k ward caste 27.4 25.2 21.5

Other 24.8 21.6 23.6

Standard of living

Low 28.8 26.9 26.0

Medium 27.2 22.8 20.9

High 22.5 19.0 13.5

Number of living children

0 25.3 16.0 20.8

1 30.9 29.1 32.0

2 28.5 25.8 20.8

3 24.6 23.4 19.0

4+ 25.8 24.1 22.4

it fatalistic (9%) while a similar proportion of women (8%)

cited the reason that contraceptive “interferes with body”.

“Health concerns” was cited by about 12% of women as a rea-

son for not using contraception for limiting children.

Table 4 presents main reasons for not using contraception

among currently married women by selected background char-

acteristics. Opposition to use is the most cited reason for not

using family planning across background characteristics. With

increasing age, method related reasons such as health concerns,

fear side effects, cost too much and interference with body be-

come dominant. For instance—only 14% women aged 20 - 24

years cited method related reasons compared to 36% among

those aged 45 - 49 years. About two-thirds of women from rural

areas cited opposition to use as the main reason for not using

family planning. Although a majority of women urban areas

also cited opposition to use a main reason, about one-third of

them cited method-related reasons to be the main reason behind

non-use of family planning.

About 50% of women who had 10 or more years of school-

ing cited fertility related reasons. When women were classified

by standard of living, about 50% of women with high standard

Table 3.

Main reasons for not using contraception by unmet for spacing and

limiting in Bihar, 2005-2006.

Main reasons for not

using contraception For spacing For limiting

Fertility re l a ted

Infrequent sex, no sex 10.0 7.6

Menopausal, hysterectomy 0.0 0.0

Sub fecund, in fec und 0.0 0. 4

Wants more c hildren 5.3 0.0

Opposition to use

Responde nt opposed 9.3 10.3

Husband opposed 12.3 16.2

Others opposed 2.3 2.9

Religion prohi bit s 37.8 25.4

Fatalistic 2.3 8.6

Lack of knowledge

Knows no method 7.0 1.9

Knows no source 3.0 0.0

Method related

Health con cerns 0.7 12.0

Fears side effects 4.6 4.7

Cost too m uch 0.0 2.3

Interferes w i th body 0.0 7.6

Other 0.0 0.0

Don’t know 5.3 0.0

Total 100.0 100.0

160

A. KUMAR, A. SINGH

Table 4.

Main reasons for not using contraception among currently married

women (15 - 49 years) with unmet need by selected background char-

acteristics in Bihar, 2005-2006.

Background

characteris tics Fertility

related Opposition

to use Lack of

knowledge Method

Respondent ’s age

15 - 19 38.9 61.1 0.0 0.0

20 - 24 7.1 60.7 17.9 14.3

25 - 29 6.5 83.9 3.2 6.5

30 - 34 4.5 77.3 4.5 13.6

35 - 39 4.5 50.0 0.0 45.5

40 - 44 5.0 65.0 0.0 30.0

45 - 49 18.2 45.5 0.0 36.4

Place of residence

Urban 13.3 46.7 6.7 33.3

Rural 10.8 66.9 5.0 17.3

Respondent ’s education

Illiterate 8.7 68.3 4.8 18.3

Primary 0.0 100.0 0.0 0.0

Secondary 22.2 44.4 5.6 27.8

High school 50.0 50.0 0.0 0.0

Religion

Hindu 16.3 48.8 8.1 26.7

Muslim 4.5 86.4 0.0 9.1

Caste

Scheduled c aste 23.5 47.1 5.9 23.5

OBC 12.6 60.9 6.9 19.5

Other 4.1 77.6 0.0 18.4

Standard of living

Low 13.7 61.6 8.2 16.4

Medium 6.1 69.4 4.1 20.4

High 7.1 42.9 0.0 50.0

Number of living children

None 46.2 53.8 0.0 0.0

1 13.6 63.6 13.6 9.1

2 4.5 68.2 4.5 22.7

3 22.2 61.1 0.0 16.7

4+ 3.9 67.5 3.9 24.7

Note: OBC stands for Other Backward Castes.

of living cited method related reasons while between 60% to

70% women with medium and low standard of living mention

opposition to use as main reason. About 86% of Muslim

women cited opposition to use as main reason for not using

family planning compared to 49% of Hindu women. A greater

percentage of women with no child (46%) cited fertility related

reasons. The proportion of women citing method related rea-

sons increased with number of living children.

Socioeconomic Correlates of Unmet Need for Family

Planning

Table 5 presents the odds ratios from logistic regression

analysis. A number of explanatory variables such as women’s

age, religion, standard of living and number of living children

have been found to be statistically significant determinants of

unmet need for family planning in Bihar. Beginning with age

group 20 - 24, increasing age is associated with a progressive

decrease in total unmet need; these results are highly significant

(at the 0.1% level). Women from age group 20 - 24 were 57%

less likely to have unmet need for family planning compared to

the reference group i.e. 15 - 19. The likelihood of unmet need

was even smaller among oldest reproductive age group (45 -

49). After controlling for several background characteristics,

the unmet need for family planning was significantly higher

among Muslim women (OR = 1.88; p < 0.05) than Hindu

women. Belonging to Other Backward Castes (relative to

Scheduled Castes) was associated with significant decrease in

unmet need. The unmet need for family planning was less

likely to be found among women belonging to high standard of

living category (OR = 0.55; p = 0.00) compared to those be-

longing to low standard of living category. A progressive in-

crease in the odds could be noticed with increase in the age at

marriage. The odds of unmet need were about 40% higher

among women who married between 15 to 18 years of age than

among those whose age at marriage was less than 15 years. The

number of living children is significantly associated with the

unmet need of women. A progressive increase in the odds can

also be seen in terms of increasing number of living children.

The odds of unmet need were about three times higher among

those who had one or two children compared to those who had

none. The odds were even greater among women with three

(OR = 3.69; p = 0.00) and four or more children (OR = 7.62; p

= 0.00).

Discussion and Conclusion

Using information on currently married women from nation-

ally representative survey, this study attempted to study trends,

differentials and determinants of unmet need in the state of

Bihar. It emerges from the analysis that the unmet need for

family planning among currently married women has been

steadily declining over the study period (1992-2006). This to

some extent can be attributed to the efforts of family planning

program. The met need for spacing methods is very small as

compared to unmet need. This could be attributed to poor per-

formance of family planning program in Bihar. It has failed to

provide people with enough choices and range of contracep-

tives for spacing. The family planning program in Bihar like

many o ther st ates in I ndia has prima rily focuse d on ste riliz atio n.

There has been little incentive for program managers or grass

root health workers to promote contraceptive methods for

A. KUMAR, A. SINGH

Table 5.

Results of logistic regression showing determinants of unmet need for

family planning among currentl y married women in Bihar, 2005-2006.

Background

characteris tics Odds Ratio p-value Confidence Interval

at 95% leve l

Respondent ’s age

15 - 19®

20 - 24 0.43 0.00 0.28 - 0.65

25 - 29 0.27 0.00 0.17 - 0.44

30 - 34 0.14 0.00 0.08 - 0.24

35 - 39 0.09 0.00 0.05 - 0.16

40 - 44 0.06 0.00 0.03 - 0.11

45 - 49 0.03 0.00 0.01 - 0.07

Place of residence

Urban®

Rural 1.19 0.17 0.92 - 1.52

Respondent ’s education

Illiterate®

Primary 1.49 0.02 1.05 - 2.13

Secondary 1.15 0.39 0.82 - 1.61

High school a nd above 0.85 0.72 0.35 - 2.04

Caste

Scheduled ca ste®

Other backward castes 0.74 0.04 0.55 - 0.99

Other 0.82 0.34 0.55 - 1.22

Religion

Hindu®

Muslim 1.87 0.05 1.57 - 2.81

Other 1.06 0.05 1.03 - 2.17

Standard of living

Low®

Medium 0.85 0.23 0.66 - 1.10

High 0.54 0.00 0.37 - 0.80

Women working status

Not working®

Working 0.99 0.99 0.77 - 1.27

Age at marriage

<15®

15 - 16 1.38 0.01 1.07 - 1.80

17 - 18 1.40 0.03 1.03 - 1.88

>18 1.85 0.00 1.25 - 2.74

Number of living children

No child®

1 2.83 0.00 1.84 - 4.34

2 3.09 0.00 1.90 - 5.02

3 3.69 0.00 2.19 - 6.18

4+ 7.62 0.00 4.50 - 12.89

Note: ®stands for reference category.

spacing (Laya, 2012). Thus, it is not surprising that pregnancies

still go unplanned. The unmet need for family planning remains

substantially high in Bihar similar to its neighboring states such

as Uttar Pradesh, Jharkhand, Orissa and Chhattisgarh. Despite

steady decline in total unmet need, the unmet need for limiting

purposes has been on increase, which indicates that unwanted

pregnancies due to lack of limiting methods are on the rise in

Bihar. Socio-economic differentials in unmet need indicate that

there are many sub-groups such as adolescents, poor, illiterates,

SC/ST, Muslims where the unmet need has either increased or

stagnated over the study period. Government should not only

focus on spacing methods but also try to target groups to en-

courage conceptive use among them.

We also analyzed main reason for not using family planning

methods for limiting or spacing. Opposition to use emerges as a

major constellation of reasons while other three constellations

of the reasons were not cited very often. Within “opposition to

use”, religious prohibition and the opposition of husband and

sometimes opposition from the respondent herself were the

main reasons for not using contraception. It is not surprising

since Bihar is considered socioeconomically one of the most

underdeveloped states in India. This largely traditional and poor

society is still characterized by low literacy not only among

women but also among men. Issues such as contraception in

these societies are generally avoided and not talked about.

Hence, it is not surprising why opposition from husband or wife

is the main reason for not using family planning. Another im-

portant finding suggests that the unmet need among Muslim

women is very high in Bihar as compared to Hindus. Another

main reason for not using family planning is method related. A

little more than one-fourths of women cited this as main reason

in Bihar in 2005-2006.

“Method-related” reasons for not using family planning were

also prominently mentioned by women from some socioeco-

nomic sub-groups. For instance, the proportion of women citing

this as main reason for not using family planning was more in

urban areas than in rural areas. It may be due the fact that

women in urban areas are generally more aware of method-

related problems than rural women. Similar explanation could

be given for the women from high standard of living category

where more than 50% women reported “method-related” rea-

sons. “Method-related” reasons were also prominently cited

among Hindu women compared to Muslims. A considerable

proportion of older women also cited this as main reason. Bi-

har’s family planning program needs to focus on these groups

of women where the proportion of women reporting

“method-related” reasons or “opposition to use” as main rea-

sons for not using family planning. With information, education

and communication activities in the communities and continu-

ous improvements in the quality of family planning services, it

is possible to increase the level of contraceptive use (Mishra et

al., 1999).

We also analyzed socioeconomic covariates of unmet need

using logistic regression where we could control for other co-

variates. It emerges from the analysis that the unmet need is

likely to decrease significantly with increasing age of women. It

is perhaps the experience and awareness about contraception

among older women that reduces the likelihood of unmet need

among them. Age at marriage is significantly affecting the like-

lihood of having unmet need for family planning. Due to

physical immaturity, married girls below 15 years are not ex-

pected to give birth to children. However, those who marry

162

A. KUMAR, A. SINGH

later are generally probably more educated and know the risks

of early childbearing and try to avoid pregnancy. The women

from high standard of living category are generally more edu-

cated and aware about spacing and limiting methods available.

Since, they belong to rich families; money is not an obstacle in

seeking family planning services unlike poor women. Muslim

women are more likely to have unmet need. As discussed above,

religious prohibition is the major cause of such a high likeli-

hood of unmet need among Muslim women in Bihar. Apart

from that, Muslim women generally have lower autonomy.

Their poor socioeconomic conditions make them even more

vulnerable to not using contraception. Among women with one

living child, one hardly uses contraceptives for spacing or lim-

iting. Therefore, the strong odds for women with more than one

child should not come as a surprise. Previous studies have es-

tablished that women who are regularly exposed to electronic

mass media are less likely than other women to report method

related problems or opposition to use as their main reason for

not using family planning. However, in our study, it did not

appear to be significant when controlled for other predictor

variables.

One of the immediate objectives of the National Population

Policy of Government of India (NPP, 2000) was to meet the

unmet need of family planning. However, unmet need in the

states like Bihar is still very high. The Government of India and

particularly that of Bihar will have to take immediate steps to

address the causes of high unmet need for family planning

among women. As discussed above, the focus of policies and

programs should be on spacing methods. It is also imperative to

focus on disadvantaged groups such as Muslim, SCs, adoles-

cent and poor women. Since a great proportion of women indi-

cated that their partner opposed the use of contraception, males

(partner) should be involved in the counseling. It emerges from

the analysis that method-related reasons were also important in

shaping the decision to use or not use the contraceptives. Con-

sidering this fact, family planning program in Bihar should also

focus on eliminating misconceptions and fear about contracep-

tion through proper counseling of couples and information,

education and communication (IEC) activities in the commu-

nity, and try to improve the quality of advice and care services

related to family planning.

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