Of the two most populous countries in the world, China has experienced a large and remarkably rapid fertility transition in recent years, whereas the fertility rate in India has declined at a much slower rate. Family planning methods play a crucial role in controlling fertility and WHO statistics for 2006 show that in China the contraceptive prevalence was almost 85 per cent, while in India it was only 56 per cent. The District Level Household Surveys (DLHS) carried out in India in 2002-04 and 2007-08 show only a marginal increase in the proportion of women using family planning methods.
Contraceptive use in India is characterised by the pre-dominance of female sterilisation and substantial levels of discontinuation of temporary methods. According to the DLHS survey of 2007-08 about 54.8 per cent of ever-married women in the age group of 15 to 49 years were using family planning methods, most of which included modern methods like sterilisation, IUDs, pills, condoms and so on. Of all the different methods, female sterilisation had the highest share at 35.8 per cent and male sterilisation the lowest at 1.1 per cent. The sex composition of children was crucial when going in for sterilisation — the share of women choosing sterilisation was low at 24.9 per cent for women with two living daughters, compared to 46.6 per cent for women with at least one son. Interestingly, women with 10 or more years of education were less likely to use female sterilisation — only 26.2 per cent chose sterilisation as they preferred modern spacing methods in higher proportion.
When it comes to awareness, 98 per cent of women knew about female sterilisation, but only 83 per cent were aware that male sterilisation was also an option. Awareness among women about male sterilisation was particularly low in Meghalaya (35.1 per cent) and Assam (51.7 per cent). Looking at the wealth quintiles, awareness of male sterilisation in the lowest segments was significantly lower than the highest quintile. However, when it came to exercising the option, male sterilisation was marginally higher in the lowest segments, possibly due to cash incentives given by government programmes. (Click here for graph)
| CONCEIVED NOTIONS Share of ever-married women in the age group 15-49 years (%) | ||||
| Wealth Quintiles | Awareness of male sterilisation | Awareness of female sterilisation | Use of male sterilisation | Use of female sterilisation |
| Lowest | 72.2 | 95.3 | 1.3 | 28.1 |
| Highest | 92.5 | 99.5 | 1.1 | 35.0 |
| OFF THE FAMILY WAY Percentage of currently married women using contraceptive method (%) | |
| Male sterilisation | 1.1 |
| Female sterilisation | 35.8 |
| IUD | 1.8 |
| Pill | 3.6 |
| Emergency Contraceptive Pill | 0.3 |
| Condom | 5.5 |
| Rhythm method | 4.4 |
| Withdrawal | 2.0 |
| Not using any method | 45.5 |
The proportion of women going in for sterilisation varies widely across states, ranging from six per cent in Manipur to 61.6 per cent in Andhra Pradesh. In five states, Puducherry, Maharashtra, Tamil Nadu, Karnataka and Andhra Pradesh, more than half of the women surveyed were sterilised, while in six states – Manipur, Meghalaya, Lakshadweep, Assam, Tripura and Uttar Pradesh – less than 10 per cent of women had opted for sterilisation. Though male sterilisation is very low across the country, there are again wide variations from a mere 0.1 per cent in Meghalaya and Mizoram to 7.8 per cent in Himachal Pradesh. In 20 states male sterilisation was less than one per cent but more than four per cent male sterilisation was also reported in Sikkim, Dadra and Nagar Haveli and Andhra Pradesh.
The burden of family planning falls disproportionately on women the world over. In developing countries like India, there are numerous reasons for this — lack of awareness of different methods, opposition from husbands, lack of method satisfaction, fear of side-effects, poor access to family planning services and so on. Though education and awareness can help women make more choices, clearly the world has a long way to go for real gender equality.
Indian States Development Scorecard, a weekly feature by Indicus Analytics, focuses on the progress in India and across the states across various socio-economic parameters.
