The Effect of Community-Based Reproductive Health Communication Interventions on Contraceptive Use among Young Married Couples in Bihar, India

Article excerpt

CONTEXT: Contraceptive use among young couples in India is low, and early childbearing and short birth intervals are common. The PRACHAR Project, an ongoing intervention in Bihar, seeks to increase contraceptive use for delaying and spacing births through communication interventions.

METHODS: Random samples of married younger than 25 with no more than one child were surveyed in 2002-2003, before PRACHAR was implemented (N = 1,995), and in 2004, 21-27 months after implementation (N=2,080). Contraceptive demand and use, and related attitudes and knowledge, were assessed in the two surveys in both intervention areas and comparison areas. Logistic regression was used to assess the effect of the interventions on these indicators.

RESULTS: Contraceptive use was very low (2-6%) at baseline in both comparison and intervention areas. Demand for contraception increased from 25% at baseline to 40% at follow-up in intervention areas, but remained virtually unchanged in comparison areas. At follow-up, contraceptive use had risen in both areas, but the adjusted odds of use in Intervention areas were 3.8 times those in comparison areas. Women in intervention areas had elevated odds of knowing that fertility varies during the menstrual cycle, and of agreeing that early childbirth can be harmful and that contraceptive use is necessary and safe for delaying first births (odds ratios, 1.6--3.0).

CONCLUSION: Culturally appropriate, community-based communication programs that target youth and those who influence their decisions can create demand for contraception among young couples and lead to increased contraceptive use.

International Family Planning Perspectives, 2008, 34(4):189-197

India is home to one-sixth of the world's population, and to 30% of youth aged 10-24. (1) There are more than 211 million 15-24-year-olds in India, (2) and they account for 48% of the country's fertility. The total fertility rate in 2005-2006 was 2.7 children per woman, but there was much variation among states, from 2,0 (below replacement level) in Kerala to 4.0 in Bihar and 4.6 in Meghalaya. (3)

Early marriage and childbearing are common in India: The median age at marriage for females is 16.7, well below the legal age of 18, and 28% of women aged 20-49 gave birth before age 18. (1) Contraceptive use by mothers younger than 25 is negligible, resulting in short interpregnancy intervals. Women usually achieve their desired fertility of 2-3 children by age 25 and then adopt a permanent method.

Although contraceptive use among women younger than 25 is low, the demand for contraception in this population is high. (The National Family Health Survey classifies married women who want to wait at least two years before having a child or do not want any more children as having a demand for contraception; those who want to wait at least two years before having a child or do not want any more children but are not using a contraceptive method are considered to have an unmet need for contraception. (2) For example, in Bihar, where the mean age at cohabitation after marriage is just 17, more than a third of married women aged 15-19 (34%) and 20-24 (40%) have a demand for contraception, and similar proportions (31% and 33%, respectively) have an unmeet need for contraception (primarily for spacing). (4), (5)

The benefits of contraceptive use by young couples in India are many, especially in states where the age at marriage is very low, and levels of fertility, population growth, infant and child mortality, and abortion are high. (6) Delaying first births until age 21 and increasing the interval between the first and second births would help lower infant and child mortality, (2), (7) increase the mean age of childbearing and reduce India's high momentum effect * on population growth. (8)

Cultural barriers impede young women in rural India, especially northern India (including Bihar), from postponing childbearing. …