Young Couples in India: How to Meet Their Contraceptive Needs to Space Births?

Background: Bihar is the second most populous state (106 million) in India and has highest total fertility rate (3.9) and a stagnated contraceptive prevalence rate of modern methods (29 percent). The unmet need for contraception is high.
Data and Objectives: Based on a large sample survey (N=7995), including 2937 women, 723 husbands and 592 health workers, and 150 in-depth interviews of women and their husbands, the present paper attempts to understand (a) who decides and how decision of contraceptive use is taken, (b) how socio-cultural norms influence contraceptive use dynamics, (c) barriers to contraceptive use and (d) where family planning program is failing to reach young couples.
Results: A combination of qualitative and quantitative approach including multivariate analysis shows a combination of socio-cultural and a weak FP program contribute to continued low use of contraception including: (a) large family size norm and son preference, (b) subordinate status of young women, low mobility outside home and lack of decision making power, (c) early marriage/pregnancy with no knowledge of fertility return leading to unwanted pregnancies; compounded by (c) programmatic inadequacies such as failure to provide correct and complete knowledge on FP, fear of side effects, and limited access to methods within village.