REGIONAL VARIATIONS IN UNMET NEED OF FAMILY PLANNING IN RAJASTHAN

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1 Health and Population - Perspectives and Issues 36 (1 & 2), 26-44, 2013 REGIONAL VARIATIONS IN UNMET NEED OF FAMILY PLANNING IN RAJASTHAN Sherin Raj T.*, V.K. Tiwari** and J.V. Singh 1*** ABSTRACT The objectives of this study were to assess the extent of regional variations in unmet need of contraception among married women of reproductive age group in Rajasthan and to study the factors influencing unmet need for contraception using the District Level Household Survey (DLHS-3) data. The state has been divided into four regions as per NFHS classification. Age group, caste, religion, place of residence, women education, wealth index, media exposure, death of the children are found to be significantly affecting the unmet need. The findings of the study also show that southern region has a lower unmet need and the north-eastern region has the highest unmet need of family planning in Rajasthan. It was found that 99.2 per cent of the currently married women in the age group of years knew any kind of modern method of family planning in the state. The contraceptive prevalence rate (CPR) for any method had changed marginally by 6.6 per cent points from 40.3 to 46.9 per cent from DLHS-1 to DLHS-2 and it has increased by 17 points to 58.1 per cent in DLHS-3. Unmet need for spacing is 17.3 per cent among the younger women in the years age group while for limiting, the figure is 6.1 per cent; it means older women are not interested to get pregnant may be due to social taboos. It is seen that the mean age at marriage in the north-eastern region is 17.4 years, and nearly 42 per cent of the marriages occurred below the legal age of marriage. It is observed that age of women, their place of residence, religion, education level, wealth index, media exposure, number of livebirths, and experience of child-loss were significantly associated with the unmet need of family planning across the state and among the regions. Muslim women have the highest (23.9%) unmet need than other religions in Rajasthan. Illiteracy was high among Muslims in the state. * Assistant Research Officer; ** Professor, Department of Planning and Evaluation, National Institute of Health and Family Welfare, Munirka, New Delhi. *** Director, UP Rural Institute of Medical Sciences and Research, Saifai, Etawah, Uttar Pradesh. 26

2 Due to availability of health care facilities and services including private facilities in the urban areas, there is a low unmet need in the urban areas in comparison to rural areas. The gap between unmet need for spacing and limiting is very large in cases of women who are illiterate while gap is less among women with education of 5-9 years, 10 years and above. Total unmet need in Rajasthan is 16.8 per cent among the women without exposure to media, while it is 14.5 per cent only those having media exposure. The means of possible solution to meet the unmet need of family planning services advocated by the authors include delay the age at marriage, identifying all pregnant women in the population and offer them the basic desired health care services. Key words: Unmet need, Family planning methods, Spacing, Limiting, Regional variation. More than 100 million women in less developed countries, or about 17 per cent of all married women, would prefer to avoid a pregnancy but are not using any form of family planning. More than one-fourth of the births world-wide are unplanned 1. In many countries, established national targets for increasing contraceptive prevalence and declined fertility rate could be achieved by eliminating the unmet need 2. In South Central Asia and South-east Asia, the proportion of women with unmet need is lower at 18 per cent and 14 per cent respectively. It is estimated that more than 100 million women in South Central and South-east Asia have an unmet need. 3 About twenty two per cent (21.8%) of currently married rural women in India had an unmet need for family planning in the District Level House Hold Survey- III ( ). 4 Even where the proportion of women with the unmet need is declining, the absolute number with unmet need may be growing because the population is growing (population report, 1997). 5 In a non-contracepting society, the individual women s need to limit reproduction increases with age and parity level, while birth-spacing needs generally occur early in her reproductive career. Rajasthan is one of the largest states by area in the country with a very high population growth rate. There are 32 districts in Rajasthan and have different rates of acceptance of various family planning methods. The possible reasons for the lower acceptance include cultural backgrounds, attitudes towards family planning, meagre knowledge of family planning methods, attitude of the service providers towards these communities, lack of accessibility and availability of services, and prevalence of traditional methods of birth control. 6 NFHS found that with regard to education and residence, the differences between SC/ST and non- 27

3 SC/ST populations were significant in the state. 7 In view of regional variations in Rajasthan, it is imperative to assess the extent of regional variation in unmet need of family planning among married women of the reproductive age group, and to study the reasons and factors influencing unmet need for contraception for both spacing as well as limiting. METHODOLOGY Data for the analysis of unmet need of family planning in Rajasthan was taken from the District-Level Household Survey-III (DLHS-III, ). A multi-stage stratified systematic sampling design was adopted for DLHS-3 in the state. In the state of Rajasthan, DLHS-III sample covered a total of currently married women in the age group of years. Detailed description of sampling procedure is given in the DLHS-III, Rajasthan report. 8 For regional analysis, the state has been divided into four regions according to the National Family Health Survey 2 (NFHS-2) as given in the following Table 1. TABLE 1 REGIONAL CLASSIFICATION OF DISTRICTS IN RAJASTHAN Region Districts Western Region (13629)* North-eastern Region (14527)* Southern Region (4735)* Ganganagar, Bikaner, Churu, Jaisalmer, Jodhpur, Nagaur, Pali, Barmer, Jalor, Sirohi, Hanumangarh (11 districts ) Jhunjhunu, Alwar, Bharatpur, Dhaulpur, Sawai Madhopur, Jaipur, Sikar, Ajmer, Tonk, Bhilwara,Dause, Karauli (12 districts) Dungarpur, Banswara, Udaipur, Rajasmond (tribal dominated) South-eastern Chhitaurgarh, Bundi, Kota, Jhalawar, Baran (Hadoti Area) Region (5906)* * Sample size in each region from DLHS-3 given in bracket, Source: NFHS-II Chi-square test was applied to find out the association between the unmet need and other independent variables. Logistic regression technique has been applied to study the net effect of each variable. Cross tables have been generated on awareness of contraceptive methods, CPR, age group, religion, caste, place of residence, wealth index, education of women, media exposure, number of living children and children died with unmet need by region using SPSS software. 28

4 FINDINGS In the District Level House Hold Survey report, , it was found that 99.2 per cent of the currently married women in the age group of years knew any kind of modern method of family planning in Rajasthan. The regional analysis shows that the awareness on modern method of family planning was more than 98 per cent in all the regions. Knowledge of contraception was widespread even among adolescents. Knowledge on male and female sterilization method was also more than 90 per cent in all the regions except north-eastern Table 2. TABLE 2 AWARENESS OF CONTRACEPTIVE METHODS AMONG THE CURRENTLY MARRIED WOMEN IN RAJASTHAN Regions Any meth-od Any modernmethod Male sterilization Female sterilization IUD Pill ECP Condom/Nirodhd Female condom Rhy Rhythm method Female Literacy Rate, 2011 Census Western Region North- Eastern Region Southern Region South Eastern Region Rajasthan Source: DLHS-III, and Census of India, A significant variation was observed in the knowledge of IUD that varied from 69.4 per cent (south-eastern region) to 82.1 per cent (southern region). Awareness on emergency contraceptive pills (ECP) was above 50 per cent. Knowledge on female condom was found to be very less, less than 10 per cent in all the regions and in southern regions it was the lowest with 2.6 per cent. Awareness on condom was above 80 per cent in all the regions. The traditional method, like rhythm was found to be 52 per cent amongst the women in Rajasthan. With regard to the contraceptive prevalence rate, it is quite lower than the awareness level which indicates a gap between knowledge and practices of any type of family planning method due to various barriers. 29

5 The contraceptive prevalence rate (CPR) for any method had changed marginally by 6.6 per cent points from 40.3 to 46.9 per cent from DLHS-1 to DLHS-2 and it has increased by 17 points to 58.1 per cent in DLHS-3. CPR for any method is the highest in southern region (61.2%) and the lowest in north-eastern region (52.3%). A huge gap has been observed between rural and urban CPR in each region. CPR by modern methods also has similar kind of variations among the regions. Figures in Table 3 show that traditional methods were accepted by very few (2.7%) couples in Rajasthan. TABLE 3 CONTRACEPTIVE PREVALENCE RATE (CPR) BY REGION AND PLACE OF RESIDENCE CPR of any Method CPR of any Modern Method CPR of Traditional Method Rural Urban Total Rural Urban Total Rural Urban Total Western North- Eastern Southern South Eastern Rajasthan Source: Prepared from DLHS-3 data The levels of unmet need vary substantially by the women s social, economic and demographic characteristics. Unmet need has a close relationship with the age of women. Younger women (15-24 years) have a greater unmet need for spacing than limiting. Unmet need for spacing is 17.3 per cent among the women in the years age group while for limiting, the figure stands at 6.1 per cent. But the total unmet need in this age group is 23.4 per cent in the state. It may be due to the fact that immediately after marriage, young women are not ready to become pregnant/mothers. On the other hand, even after first birth, many couples tried to use contraception to protect themselves from conception for at least 4 to 5 years. At the same time, the pattern of unmet need among women in the age group of years is reversed. Here, the pattern of unmet need for spacing is much lower than the pattern of unmet need for limiting. The reason may be that at the age of years, most of the couples in India reached their desired family size. Similarly, a woman who conceived children in quick succession or at an early age or continue to have children when grand children have started arriving; may be criticised by the society. At this stage, the demand for limiting family is more important than spacing. So, in latter age, the unmet need for family planning is 30

6 basically due to either they had completed their desired fertility-level or women are not ready to get pregnant at an older age due to social constraints/taboos. Table 4 reveals a statistically significant association in each region with unmet need of spacing and total unmet need in the age groups. Unmet need of spacing is the highest in the western region amongst all the age groups, and the lowest in the southern region. The north-eastern region has the highest unmet need of limiting (11.2%) and southern region has the lowest (4.2%). A high level of unmet need of family planning persists in the north-eastern region. The north-eastern region consists of Jhunjhunu, Alwar, Bharatpur, Dhaulpur, Sawai Madhopur, Jaipur, Sikar, Ajmer, Tonk, Bhilwara, Dausa and Karauli districts. As per the DLHS-3 report, mean age at marriage in this region is found to be 17.4 years, and nearly 42 per cent of the marriages occurred at below the legal age at marriage. TABLE 4 UNMET NEED BY AGE GROUP OF CURRENTLY MARRIED WOMEN AND REGION Spacing Limiting Total Unmet Western Region *** ᵴᵴᵴ North-Eastern *** ᵴᵴᵴ Total Total Total *** Southern ᵴᵴᵴ South-Eastern *** ᵴᵴᵴ ***Rajasthan ᵴᵴᵴ Source: Calculated from DLHS-3,, Significant unmet at ***P< 0.001, Significant unmet spacing at ᵴᵴᵴ P<0.001; Significant unmet limiting at P<0.001 If we see the pattern of unmet need in Rajasthan across religion (Table 5), Muslim women have the highest (23.9%) unmet need than other religions in Rajasthan. Illiteracy was high among Muslims in the state. Statistically significant (P<0.001) association was observed for unmet need of spacing, limiting and total unmet among the Muslim women in the western region and north-eastern regions. Regarding the unmet need of spacing, western region has the highest with 7.2 per cent and it is 10.4 per cent among Muslims while for limiting, north-eastern region has the highest unmet need (11.2%) and it is 18.5 per cent among Muslims. The southern and south-eastern districts have 2 per cent and 6.4 per cent Muslims respectively. The districts in the north-eastern regions comprise more than 10 per cent Muslim women. 31

7 TABLE 5 UNMET NEED OF FAMILY PLANNING BY RELIGION Spacing limiting Total Region H M O T H M O T H M O T Western *** ᵴᵴᵴ North-Eastern *** ᵴᵴ Southern South-Eastern Rajasthan *** ᵴᵴᵴ Source: Prepared from DLHS-3 data , Significance unmet at *P<0.05, ** P<0.01, ***P< 0.001, Significant unmet spacing at ᵴ P<0.05, ᵴᵴ P<0.01, ᵴᵴᵴ P<0.001 Significant unmet limiting at P<0.05, P<0.01, P<0.001; H- Hindu, M- Muslim, O- Others, T- Total The pattern of unmet need for family planning services among different social groups varies due to their own perception regarding fertility control. This may be due to communication gap between service providers and acceptors. Across the social groups, it is seen that the level of unmet need for spacing, limiting and total family planning is much higher among SCs than the other social groups. But at the same time, if we see the variation between unmet need of contraception for limiting and spacing, unmet need for limiting is much higher than unmet need for spacing among SCs. So, the gap is large in case of SCs between unmet for spacing and limiting. In case of other social groups, the gap is very narrow. The reason may be due to the acceptance of available services. In north-eastern region unmet need for spacing among SC is 8.6 per cent while it is only 3.5 per cent in the southern region. Among SCs, the unmet of limiting and spacing has much variation, unmet need of limiting is much higher (10.2%) than spacing (7.2%) as compared to other social groups. TABLE 6 UNMET NEED OF FAMILY PLANNING BY CASTE GROUPS Spacing Limiting Total Regions SC ST OBC Others Total SC ST OBC Others Total SC ST OBC Others Total Western ** -North Eastern ** ᵴᵴᵴ

8 Spacing Limiting Total Regions SC ST OBC Others Total SC ST OBC Others Total SC ST OBC Others Total Southern South- Eastern *** ᵴᵴ Rajasthan *** ᵴᵴᵴ Significance unmet at *P<0.05, ** P<0.01, ***P< 0.001, Significant unmet spacing at ᵴ P<0.05, ᵴᵴ P<0.01, ᵴᵴᵴ P<0.001 Significant unmet limiting at P<0.05, P<0.01, P<0.001 The location factors play a crucial role in case of success of any programme. If we see the rural-urban differential in unmet need in Rajasthan, there is a clear-cut divide. The level of unmet need in rural area is much higher than the urban area. The reason of high unmet need in rural area may be due to the gap between the demand and supply for family planning services or may be due to the gap between family planning service providers and acceptors. It may also be due to lack of women autonomy as the unmet need may be the result of husband s decision regarding acceptance of family planning. In many cases, women said they are not ready to get pregnant but their partners did not use any preventive measures to control fertility at the time of intercourse. But in the urban context, due to availability of facilities and services including private facilities, there is a low unmet need. In each region, it is clear from Table 7 that the rural women have higher unmet need than their urban counterparts including spacing and limiting. In the western region, rural couples have the highest unmet need for spacing with 7.6 per cent and for limiting rural north-eastern region with 11.5 per cent. TABLE 7 UNMET NEED OF FAMILY PLANNING BY PLACE OF RESIDENCE Spacing Limiting Total Region Rural Urban Total Rural Urban Total Rural Urban Total *** Western ᵴᵴ *** North-Easternᵴ *Southern ᵴᵴ ** South-Easternᵴᵴ *** Rajasthan ᵴᵴᵴ Significance unmet at *P<0.05, ** P<0.01, ***P< 0.001, Significant unmet spacing at ᵴ P<0.05, ᵴᵴ P<0.01, ᵴᵴᵴ P<0.001, Significant unmet limiting at P<0.05, P<0.01, P<

9 Data given in Table 8 are adversely related to the level of unmet need for family planning in Rajasthan. It is often said that wealth index is the proxy for standard of living. So, higher the standard of living, lower will be the unmet need for family planning. Many a times, government family planning services are not satisfactory for the clients. In such cases, poor people drop family planning services while rich people avail service from private doctors with higher expenses. In case of Rajasthan, the gap of unmet need between poor and rich is not much large but in case of unmet need for limiting, it is larger. If we compare unmet need for spacing and limiting among poor, the gap is very large. But in case of rich people, the gap is very small. Even rich people have lower unmet need as compared to the state s total unmet need in both limiting and spacing. Unmet need varies much from region to region with the wealth index (Table 8). Again for the unmet need of limiting, the gap between poor and rich is much larger then spacing. As far as the unmet need of spacing is concerned, middle group has a higher unmet need than both poor and rich wealth index groups. Here, the western region has the highest unmet need of spacing with 7.8 per cent (middle) and the lowest by the rich group in the southern region with 3.4 per cent. TABLE 8 UNMET NEED OF FAMILY PLANNING BY WEALTH INDEX Spacing Limiting Total Regions Poor Middle Rich Poor Middle Rich Poor Middle *** Western *** North-Eastern ** Southern *** South-Eastern *** Rajasthan Significance unmet at *P<0.05, ** P<0.01, ***P< 0.001, Significant unmet spacing at ᵴ P<0.05, ᵴᵴ P<0.01, ᵴᵴᵴ P<0.001Significant unmet limiting at P<0.05, P<0.01, P<0.001 Rich We often consider education as the key factor to bring social and economic changes. When we talk about the decline of fertility, we give due emphasis on education and often say that increase in education level will decline fertility. From the figures given in Table 9, it is seen that increase in the level of education has shown fluctuating trends in the unmet need in the state. Unmet need for spacing and limiting varies with increasing level of education. The gap between unmet need for spacing and limiting is very large in cases of women who are illiterate while gap is less among women with education of 5-9 years, 10 years and above. 34

10 For spacing, unmet need among illiterate women is 5.5 per cent; while for limiting, it is 10.3 per cent in Rajasthan. Even the level of unmet need is very low in cases of illiterate women but gap between spacing and limiting is high as compared to those who have higher education. TABLE 9 UNMET NEED OF FAMILY PLANNING BY EDUCATIONAL LEVEL OF WOMEN IN RAJASTHAN Unmet need of Spacing Unmet need of limiting Total Unmet need Regions Non- Literate Less than 5 yrs 5-9 yrs schooling 10 and above rs Non- Literate Less than 5 yrs 5-9 yrs schoolng 10 and above rs Non- Literate Less than 5 yrs 5-9 yrs schoolng 10 and above rs Western * ᵴᵴᵴ North-Eastern ᵴᵴ Southern ᵴ South-Eastern ᵴᵴ Rajasthan * ᵴᵴᵴ Significance unmet at *P<0.05, ** P<0.01, ***P< 0.001, Significant unmet spacing at ᵴ P<0.05, ᵴᵴ P<0.01, ᵴᵴᵴ P<0.001 Significant unmet limiting at P<0.05, P<0.01, P<0.001 Unmet need for spacing among the illiterates is the highest in the western region with 6.2 per cent and the lowest in the southern region with 4.1 per cent. A similar pattern exists for those who have less than 5 years of schooling, while the unmet need of spacing is the highest in north-eastern region with 10.3 per cent among women with 5-9 years of schooling. As far as the unmet need of limiting among the illiterate women is concerned, a large gap is observed between the western region with 11 per cent and the southern region with 4.3 per cent. In the western region, the gap between illiterates and higher educated (10+ years) group is bigger than the rest of the region for unmet need for limiting. Similar variation is also seen in the total unmet need. It proves that education is a big factor in determining family planning practices and unmet need. Figure 1 reveals that women with exposure to media have a positive impact on the unmet need for family planning. Total unmet need in Rajasthan is 16.8 per cent among the women without exposure to media, while it is 14.5 percent only those having media exposure. For unmet need of spacing and limiting, similar variations can be observed. Similar kind of pattern is seen in most of the regions for unmet need of spacing and limiting. It was also seen from the diagram that those who are exposed to media has lesser level of unmet need. 35

11 FIGURE 1 UNMET NEED OF FAMILY PLANNING BY EXPOSURE OF MEDIA AND REGION, RAJASTHAN Western *** North-Eastern *** Southern * South-Easternᵴᵴ Rajasthanᵴ *** 0 Media Exposure No Media Exposure Media Exposure No Media Exposure Media Exposure Spacing Limiting Total No Media Exposure Significance unmet at *P<0.05, ** P<0.01, ***P< 0.001, Significant unmet spacing at ᵴ P<0.05, ᵴᵴ P<0.01, ᵴᵴᵴ P<0.001 Significant unmet limiting at P<0.05, P<0.01, P<0.001 From Table 10, it is clear that the unmet need of spacing and number of live birth have a negative relationship; while with unmet need of limiting have positive relationship with number of live births. As in case of zero to one live birth, the level of unmet need for spacing is very high as compare to 2-3 and 4 and above live births. That means those who don t have any live birth or one live birth they want child in future but not right now. It may be, they are not ready to become pregnant right now, so they tried to delay or spacing and thus unmet need for spacing is higher than limiting. Another reason may be, for better care of child, they may want gap and also may be maternal physical recover. In case 2 to 3 live births, they have more unmet need for limiting than spacing and same trend continued up to living children more than four. TABLE 10 NO. OF LIVE BIRTHS AND UNMET NEED BY REGION Regions 0-1 live birth Unmet need of Spacing Unmet need of limiting Total Unmet need 2-3 Live births 4 and above 0-1 live birth 2-3 Live births 4 and above 0-1 live birth 2-3 Live births 4 and above Western ᵴ *** ᵴᵴ North Eastern ᵴᵴᵴ *** Southern *** ᵴᵴᵴ

12 Unmet need of Spacing Unmet need of limiting Total Unmet need South Eastern *** ᵴᵴᵴ Rajasthan *** ᵴᵴᵴ Significance unmet at *P<0.05, ** P<0.01, ***P< 0.001, Significant unmet spacing at ᵴ P<0.05, ᵴᵴ P<0.01, ᵴᵴᵴ P<0.001, Significant unmet limiting at P<0.05, P<0.01, P<0.001 Region-wise analysis shows that the total unmet need is the highest in the northeastern region with 23.0 per cent among the women who had one live-birth or no live-birth; while the total unmet need was the lowest in the southern region in the same category. Those women experienced live-births up to 4 or above had the highest unmet need of limiting in the north-eastern region with 16.5 per cent followed by the western region with 15 per cent. All the regions have a highly significant association with number of live- birth and unmet need of spacing, limiting and total unmet. FIGURE 2 CHILDERN DIED AND UNMET NEED BY REGION Western ᵴᵴᵴ North-Eastern ᵴᵴᵴ Southernᵴ** 0 Children died Children not died Children died Children not died Children died Children not died Spacing Limiting Unmet South-Eastern ᵴᵴᵴ Rajasthanᵴᵴᵴ Significance unmet at *P<0.05, ** P<0.01, ***P< 0.001, Significant unmet spacing at ᵴ P<0.05, ᵴᵴ P<0.01, ᵴᵴᵴ P<0.001 Significant unmet limiting at P<0.05, P<0.01, P<0.001 Experience of child-loss also influences unmet need in the regions and state. The unmet need of spacing and limiting is higher among the women those who did not experience any child-loss (Fig. 2). Region-wise analysis shows that the northeastern region has the highest unmet need for spacing, limiting and total unmet among the mothers those did not loss children and this category of women were the lowest in number in the southern region. 37

13 Logistic Regression Analysis The effect of selected variables of unmet need for family planning is analysed by performing logistic regression analysis. The variables significant at 5 per cent level with chi-square test were included in the logistic regression analysis. TABLE 11 LOGISTIC REGRESSION ANALYSIS RESULTS WITH DEPENDENT VARIABLE UNMET NEED Age Group Caste Religion *** 0.555*** 0.335*** *** 0.373*** 0.173*** General Scheduled caste 1.207* * Scheduled tribe OBC Hindu Muslims 1.466*** 1.778*** 1.768*** Others Place of Residence Rural Urban Women Education Non-Literate Less than 5 yrs yrs schooling and above yrs ** 1.194** Wealth Index Rich Middle 1.559*** 1.556*** 1.616*** Poor 1.452*** 1.354*** 1.439*** Media Exposure No Exposure Exposure ** 0.922* No. of Live births *** 5.773*** 0.833*** *** 9.192*** 1.125* Children Died No Yes 1.305** * 38

14 Regions South-Eastern Western 1.505*** 1.241*** 1.363*** North-Eastern 1.324*** 1.533*** 1.512*** Southern *** 0.633*** Significance *P<0.05, ** P<0.01, ***P< Reference Category The findings in Table 11 show that the likelihood for unmet need of spacing, limiting and total unmet need decreases as the age increases. Unmet need of spacing is 72 per cent lesser among women in the years age group as compared to women in the years age group. Similarly, for unmet need of limiting, it is 44 per cent less for women in the age group of years than among women in the years age group. It was also observed that the total unmet need is 76.5 per cent lesser among women in the age group of years in comparison to women in the age group of years. With respect to the caste of the women, the likelihood of total unmet need for spacing is 21 per cent and 11 per cent for total unmet need among women belonging to scheduled castes than women belonging to the general category. Muslim women have 47, 78 and 77 per cent more likelihood of unmet need in comparison with Hindu women for spacing, limiting and total unmet need respectively. Educational status of women has some effect with unmet need for family planning in Rajasthan. Among the women educated up to 10 th or above, 32 per cent higher chance of having unmet need for limiting, 19 per cent higher chance for limiting to illiterate women. Wealth index also shows a highly significant effect with unmet need of spacing, limiting and total. Women who come under the middle and poor wealth index groups, have nearly 62 and 44 per cent of higher likelihood of unmet need respectively in comparison to the women belonging to the high wealth index group. Women exposed to mass media have fewer chances to have an unmet need of limiting and total unmet as compared to women without exposure to mass media. Number of live-birth also shows a highly significant influence on unmet need of spacing, limiting and total. Women who have experienced 2 to 3 live-births, the unmet need of limiting is 5 times greater than the women with one live-birth or no live-birth; and women with 4 and above live-births have the unmet need which is 9 times more than women with one live-birth or no livebirth. Experience of child-loss also influences the unmet need among women in Rajasthan. The likelihood of unmet need of spacing is 30 per cent higher among women who lost children as compared to the women who did not have any child-loss. Regional analysis shows that the likelihood of unmet need of spacing is 51 per cent and 32 per cent higher in the western and north eastern regions 39

15 respectively while it is 8 per cent less in the southern region. The likelihood of unmet need of limiting is 24 per cent and 53 per cent higher in the western and north eastern regions respectively while the figure stands at 51 per cent in the southern region. As far as the total unmet need is concerned, the likelihood is 33 per cent and 51 per cent higher than the reference region and 37 per cent lesser in the southern region. DISCUSSION Although unmet need has a considerable socio-demographic significance, its root causes are still largely unknown 9. Demographic and social factors are assumed to be the underlying determinants of the unmet need for family planning. The current study has focused on the factors associated with the unmet need for family planning in Rajasthan. Attempts have also been made to assess the major reasons for the regional variations of unmet need. Western region occupies the highest total unmet need with 18.7 per cent and unmet need of limiting with 11.2 per cent, while the western region ranks the highest position in unmet need of spacing. Age of the women is very much associated with the unmet need. The unmet need of spacing is very high (17.3%) among owmen in the age group of years and it varies by region from 20.4 to 13.4 per cent in the western region and south/south-eastern region respectively. Acknowledging the deep-rooted custom of child marriages in the state, the latest data of annual health survey (AHS) indicates that nearly one-fourth of the girls are getting married before reaching the age of 18 years. 10 AHS also indicates that the mean age at marriage for females in Bhilwara district of the north-eastern region of Rajasthan is 16.8 years. As far as the religion is concerned, a significant association has been observed between religion and unmet need of spacing, limiting and total unmet in all the regions except the southern and south-eastern regions. In southern and southeastern regions, Muslim population is 2 and 6.5 per cent respectively. The unmet need of spacing is the highest among Muslims with 8.8 per cent. The regional figure varies from 4.3 per cent in the south-eastern region to 10.4 per cent in the western district. In case of limiting also, unmet need is the highest among Muslim women in Rajasthan. NFHS-3 ( ) results show that Muslim women have the highest percentage of unmet need among all the religions in the country. Similar findings have also been seen in some earlier studies in India. 9,11,12 Total unmet need is also the highest among Muslim women with 23.9 per cent and is the highest in the north-eastern region with 27.5 per cent while the lowest is found in the southern region with 7.8 per cent. Across all the social groups in Rajasthan, scheduled castes (SCs) have the highest 40

16 unmet need for spacing, limiting and total unmet need. While the regional analysis shows that other backward classes (OBCs) have the highest unmet need in western and southern region for spacing; SCs have the highest unmet need in the rest of the regions. As far as the unmet need of limiting is concerned, scheduled tribes (STs) have the highest unmet need in the western and south-eastern regions, SCs have the highest unmet need in the rest of the regions and STs have the highest number in total unmet need in the western and south-eastern regions; and SCs have the highest total unmet need in the rest of the regions. According to NFHS-3 ( ), Rajasthan shows that the unmet need of spacing is the highest among SCs as compared to other groups. Similar kinds of results have also been observed in some other studies In the present study, it is observed that wealth index and unmet need of family planning have a statistically highly significant association. Women in the poor and middle wealth index groups have nearly 42 and 44 per cent of higher likelihood of unmet need as compared to women in the high wealth index group. An earlier study also shows much closer figures with the current study 15. Middle wealth index group women of the western region have the highest unmet need of spacing with 7.8 per cent and rich wealth index group women of the southern region have the lowest unmet need with 3.4 per cent while for limiting, it is middle group of south-eastern region and the rich group of the southern region have the highest and lowest unmet need respectively. Education is considered as the key factor to bring socio-economic changes in a society. Usually, as the educational status of women increases, they will be more aware of the family planning services and hence, unmet need decreases. But in this study, it is observed that with an increase in the education level of mothers, the likelihood of unmet need of spacing, limiting and total unmet increases. Another study in EAG states found similar results among the couples 16. It may be due to the awareness among educated women and non-availability of family planning services in the area. Some other studies also found that unmet need of family planning and education of women have highly significant asscocation. 15,17 The current study found that women with exposure to media have a positive impact on unmet need for family planning. Total unmet need in Rajasthan is 16.8 per cent among the women without exposure to media, while it is 14.5 per cent only among the women with media exposure. For unmet need of spacing and limiting, similar variations can be observed. These results are similar to the findings of some other studies. 9,12,13,17 Regional analysis also shows statistically highly significant association between media exposure of women and unmet need except in the south-eastern region. There was significant association between number of live-births and categories 41

17 of unmet need. The researchers found that unmet need for limiting is much higher among the women with more than four children while unmet need of spacing for that group is much lower. Several earlier studies also have similar kind of results. 12,13,15,17 Another study on unmet need reveals that the prevalence rate of spacing methods significantly decreases and limiting methods increases with the increase in number of living children. 18 Regional analysis shows a statistically highly significant association between unmet need and number of living children. Experience of child-death is another statistically highly significant factor associated with the unmet need. Women experiencing child-death, are more likely to have unmet need for limiting than those not experiencing any child-death which is also reported in some earlier studies. 12,15 CONCLUSION AND RECOMMENDATIONS The levels of unmet need vary substantially by the women s socio-economic and demographic characteristics. According to the District Level House Hold Survey (DLHS-3, ) report, 99.2 per cent of the currently married women in the age group years know any kind of modern method of family planning in Rajasthan. Among the four regions, women in the southern region have the highest knowledge of contraception (82.1%). In the present research, southern region has the highest figures for contraceptive prevalence rates for any method, modern method and traditional method. Unmet need of limiting is the highest in the north-eastern region with 11.2 per cent. Mean age at marriage in this region is found to be 17.4 years while as per the DLHS-3 report; nearly 42 per cent of the marriages occurred below the legal age of marriage. Factors such as age of women, their place of residence, religion, education level, wealth index, media exposure, number of live-births, and experience of child-loss were significantly associated with the unmet need of family planning in the state and regions. The percentage of total unmet need is especially high among the rural women, Muslim women, women with poor wealth index and women without exposure to media messages on family planning in the state. The Government of India and particularly, that of Rajasthan will have to initiate immediate steps to address the causes of high unmet need for family planning among women in the state. It is also imperative to focus on the disadvantaged groups such as Muslim, SCs and women belonging to the poor wealth index group in the low performing western and north-eastern regions of Rajasthan. The means of possible solution to meet the unmet need of family planning services advocated include delay the age at marriage, identifying all pregnant women in the population and offer them the basic desired health care services including methods of spacing and limiting 17. The coverage of home-visits by Accredited Social Health Activists (ASHAs)/health workers also needs to be expanded. Informed 42

18 option of various available methods of contraception, proper counseling on contraception, service delivery and adequate supply of different contraceptives should be provided as per the requirements. REFERENCES 1. Haub, C. & Herstad, B. (2002). Family planning worldwide data sheet. Population Reference Bureau. 2. Westoff & Bankole. (1996). The potential demographic significance of unmet need. International Family Planning Perspectives, 22 (1): Dixon-Mueller, Ruth & Adrienne Germain. (1992). Commentary. Stalking the elusive unmet need for family planning. Studies in Family Planning 23 (5): Government of India. District Level Household Survey III, (2007). International Institute for Population Studies, Ministry of Health and Family Welfare, Mumbai. 5. Population report: Meeting unmet need. (1997). New strategies, Series J, 43: Singh, L.P. & Srinivasan, K, (2000). Family planning and the scheduled tribes of Rajasthan: Taking stock and moving forward. Journal of Health Management, 2 (1): Govindasamy, P. & Ramesh B.M. (1997). Maternal education and utilisation of maternal and child health services in India. National Family Health Survey (NFHS) Reports, Number 5. Mumbai: International Institute for Population Sciences, and Maryland: Macro International Inc. Calverton. 8. Government of India. District Level Household Survey III, Rajasthan, (2007). International Institute for Population Studies, Ministry of Health and Family Welfare, Mumbai. 9. Srivastava, D.K., Pramod, G, Roli, G., Neeraj, G. & Manoj, B. (2011). A study to assess the unmet needs of family planning in Gwalior district and to study the factors that helps in determining it. National Journal of Community Medicine; 2 (1): Government of India. (2012). Annual Health Survey , Office of the Registrar General and Census Commissioner, India. New Delhi: Ministry of Home Affairs. 11. Dwivedi, S. N. & Sundaram, K.R. (2000). Epidemiological models and related simulation results for understanding of contraceptive adoption in India. International Journal of Epidemiology, 29:

19 12. Barman, S. (2013). Socio-economic and demographic determinants of unmet need for family planning in India and its consequences. Research on Humanities and Social Sciences, 3 (3): Kumar, A, & Singh, A. (2013). Trends and determinants of unmet need for family planning in Bihar (India): Evidence from National Family Health Surveys. Advances in Applied Sociology Scientific Research, 3 (2): Ansary, R. & Anisujjaman, M. (2012). Factors determining pattern of unmet need for family planning in Uttar Pradesh, India. International Research Journal of Social Sciences, 1(4): Laya, K.S. (2012). Prevalence and determinants of unmet need for family planning among women in India. Research and Social Practices in Social Sciences, 7 (2): Sengupta, R. & Das, A. (2012). Contraceptive practices and unmet need among young currently married rural women in Empowered Action Group (EAG) states of India. Journal of Family Welfare, 58 (1). 17. Patil, S. S., Durgawale, M. P. & Patil, S.R. (2012). Epidemiological correlates of unmet need for contraception in urban slum population. Al Ameen Journal of Medical Sciences, 3 (4). 18. Bhattacharya, S. K., Ram, R., Goswami, D. N., Gupta, U. D., Bhattacharya, K. & Ray, S. (2006). Study of unmet need for family planning among women of reproductive age group attending immunization clinic in a medical college in Kolkata. Indian Journal of Community Medicine, 31 (2). 44

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