Spatial heterogeneity in discontinuation of modern spacing method in districts of India.

BACKGROUND

Despite six decades of official family planning programme, the use of modern contraceptive method remained low in India. The discontinuation of modern spacing method (DMSM) has also increased from 42.3% in 2005-06 to 43.6% during 2015-16. Discontinuation rate is higher for Injectable (51%), followed by condom (47%), pill (42%) and lowest in IUD (26%).

METHODS

Data from NFHS-4 (2015-16) comprising of 601,509 households, 699,686 women and a sample of 119,548 episode of modern spacing method was used for the analysis. Multiple decrement life table has used to estimate 12-month discontinuation rate of modern spacing methods (DMSM). Moran's I statistics, Bivariate LISA cluster map has used to understand the spatial correlates and clustering the DMSM. OLS model and impact analysis has used to assess the significant associated covariates with discontinuation.

RESULT: The 12-month DMSM in India is 43.5%; largely due to desire for becoming pregnant and method failure. The high discontinuation rate was observed in most of the southern (62%) and central (46%) regions of India. DMSM has significantly and spatially associated with neighbouring districts of India (Moran's I = 0.47, p-value = 0.00). The prevalence of modern spacing method is negatively associated with discontinuation in the neighbouring districts of India. The unmet need (β = 0.84, 95% CI 0.55-1.14), desire of children (β = 0.26, 95% CI - 0.05-0.57) and female sterilization (β = 0.54, 95% CI 0.14-0.95) were three main contributing factor to DMSM.

CONCLUSION

Districts of high DMSM need programmatic intervention. More attention for counselling to client, health worker outreach to user and better quality care services will stimulate non-user of contraception.