Contraceptive use dynamics in South Asia: the way forward

This study assesses the contraceptive use dynamics, its program and policy implications in India, Pakistan, Bangladesh and Nepal. Data from three rounds of Demographic and Health Survey (DHS) of each country were used, and the currently married women aged 15-49 years of the latest DHS were considered for detailed analysis. IBM-SPSS (Version 19.0) was used for bivariate and multi-variate analyses with a significance level of 5%.

Analyses indicate considerable intra-country differences in contraceptive use, trends, method mix and determinants. Contraceptive plateau was evident in Bangladesh and Nepal (each with 0.3 point annual increase), while contraceptive use had declined at (-0.6) points annually in Pakistan; between last two rounds of the surveys. Health care autonomy enhances the likelihood of contraceptive use in India (OR=1.06), but not in Nepal (OR=0.60) and Bangladesh (OR=0.45). Exposure to family planning messages increases the chances of sterilization acceptance in Pakistan (OR=1.32); contrary to India (OR=0.92) and Nepal (OR=0.71). Results suggest broadening of method choices with quality service delivery, reconsideration/ review of program focus, repositioning spacing methods in national programs, and demand assessment through monitoring age-sex distribution; all with country specific amendment are pertinent.