Academic journal article Journal of Health Population and Nutrition

District-Level Religious Composition and Adoption of Sterilization in India

Academic journal article Journal of Health Population and Nutrition

District-Level Religious Composition and Adoption of Sterilization in India

Article excerpt

INTRODUCTION

Choice of contraceptive methods in India is dominated by the use of female sterilization, and the use of temporary modern methods of family planning remains low (1). Although contraceptive prevalence has been climbing steadily in India over the past two decades, Muslim women have a lower uptake of family planning than Hindu women and women from other religious groups (2-7).

This paper examined the influence of religious composition of community on the decision to adopt a permanent method of family planning and also examined the contrasting influences of individual- and community-level measures of religion. An understanding of the effect of community-level religious composition on the choice of female sterilization has the potential to inform the effective delivery of family-planning services.

Background

Adoption of sterilization in India

The use of family-planning services in India is dominated by female sterilization, currently accounting for approximately 82% of all services used (1,8,9). Traditional methods are the next most commonly-used type of family planning (11% of all services used), with oral pills (3%), intrauterine devices (IUDs) (5%), and condoms (6%) accounting for small percentages of total use (10,11). The adoption of sterilization in India often marks a woman's first use of family planning, with a few who are sterilized having previously used a temporary method of family planning (1,12). The increase in contraceptive prevalence in India has been paralleled by declining fertility, with the total fertility rate declining from 5.7 in 1970 to 3.2 in 2004 (13). Much of this fertility decline has been achieved through increases in the adoption of female sterilization (14). Women commonly adopt sterilization at older ages and higher parities, with sterilized women having an average of 4 children compared to 3.1 children for all married women of reproductive age (6,8,14,15). However, a recent trend towards adopting sterilization at younger ages, particularly in southern states, indicates both a growth in small-family norms and a desire to limit exposure to unwanted pregnancies (1,16).

The reliance on female sterilization in India has its roots in the National Family Planning Programme of the 1970s, which promoted sterilization as an effective mechanism for fertility reduction (16). In 1996, the Government of India introduced a target-free approach to family planning, and the National Family Planning Programme was renamed as the Family Welfare Programme and accompanied with a shift in focus towards broader reproductive health. Such was the early success found in promoting sterilization that family planning in India is now synonymous with female sterilization (1,17). The reliance on female sterilization for family planning is also a product of the relative lack of knowledge of alternative methods of family planning (17,18). While 95% of married women of reproductive age are aware of sterilization, only 76% know of temporary family-planning methods (10,14).

Religion and family-planning use

Previous studies have demonstrated that Muslim women in India had a lower use of family-planning services than Hindu women and women from other religious groups (2-7). The highest levels (48-63%) of contraceptive prevalence were observed among the minority religious groups (Jains, Buddhists, Sikhs, and Christians), followed by Hindu women (42%) and Muslim women (28%) (11). The prevalence of sterilization among Muslim women was low at 14% compared to 29% for Hindu women and 30-35% for women from other religious groups (10). In a study of sterilization acceptance in Kerala and Goa, Rajaram observed that Hindu women adopted sterilization at younger ages than Muslim women did (6). The use of modern temporary methods was slightly higher among Muslim women (6%) than among Hindu women (5%), although women from other religious groups had the highest levels (17-22%) of the use of temporary modern methods (10). …

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