Caesarean deliveries, subsequent reproductive behaviour and children ever born in India

Against the backdrop of the alarming rise in Caesarean section (C-section) births in India, this study aimed to examine the association between C-section births, fertility decline and female sterilization in the country. A cross-sectional design was used to investigate the association between C-section delivery and subsequent reproductive behaviour in women in India. Data were from the National Family Health Survey (NFHS-4). The study sample comprised 255,726 currently married women in the age group of 15–49 years. The results showed a strong positive relationship between C-section births and female sterilization. The predicted probabilities (PP) from the multivariate regression model indicated a higher chance of female sterilization in women with C-section births (PP = 0.39, p<0.01) compared with those with non-C-section births (PP = 0.20, p<0.01). Both state-level correlation plots and Poisson regression estimates showed a strong negative relationship between C-section births and mean children ever born (CEB). Based on the results, it may be concluded that the use of C-sections and sterilization were strongly correlated in India at the time of the NFHS-4, thus together contributing to fertility decline. A strong negative association was found between the occurrence of C-sections and CEB. The increased and undesired use of C-section births and consequent female sterilization is a regressive socio-demographic process that often violates women’s rights. Fertility decline should happen through informed choice of family planning and must protect the reproductive rights of women.

Socio-demographic Factors affecting Female Sterilization Operation among Couples of Ahmedabad City : A Record Based Study

Introduction: Unplanned pregnancy may be the reason of many neonatal and maternal adverse effects. Many factors have been reported to be associated with acceptance of female sterilization. Objective: To identify various socio-demographic factors affecting the decision of choice of Tubal Ligation (TL). Method: A record based study was done using data from the register maintained at the Family Planning Unit of Obstetrics and Gynaecology department. Analysis of data of TL operations conducted between April 2018 to March 2019 were performed. Results: A total of 675 tubal ligation operations were conducted. The mean age of females undergoing TL was 28.8 ± 3.9 years and their husbands was 33.25 ± 4.38 years. Out of the total, 484(71.1%) couples were Muslims. Total 74(10.8%) females were illiterate and 39(5.8%) males were illiterate. Among 440 (65.1%) couples who had underwent TL had 3 living children. Majority i.e. 518 (76.7%) had the age of their last living child less than 1 month. Ninety one percent of couples had at least one male child. There was a significant relationship of female education with total number of living children. Relationship of total number of living children with religion was also significant statistically. Conclusion: The study concludes that female education as well as religious and cultural beliefs plays a major role in deciding the female sterilization.

709Inequalities and the role of sterilization in modern contraception in low- and middle-income countries

Background Contraceptive use has increased impressively in the last years. Our aim was to track the proportion of female sterilization in demand for family planning satisfied with modern methods (mDFPS) and its inequalities in terms of wealth. Methods Using data from national health surveys carried out since 2010 in 105 countries, we estimated mDFPS, separating according to type of method. Where the share of female sterilization was at least 25%, we analysed wealth inequalities in the share of sterilization by wealth quintiles and Slope Index of Inequality (SII). Results We included 20 countries, among which mDFPS varied widely (from 6% in Albania to 94% in Brazil). Female sterilization was reported by more than half of women in India, Dominican Republic, El Salvador, Mexico, and Colombia. Most countries presented higher use of sterilization among the richest, but inequality patterns varied greatly. Higher levels of pro-rich inequality were found for Guatemala and Costa Rica (SII of 0.24 and 0.22, respectively). Higher levels of pro-poor inequality were found for Albania and Brazil (SII of -0.25). Conclusions Despite the wider range of methods available, several countries present a large proportion of mDFPS satisfied through female sterilization. Key messages Sterilization might be recommended to some couples, however, its role in mDFPS is excessively high. Promotion of long-acting reversible contraceptives should be strengthened as they are easy to use, highly effective and do not eliminate women’s agency about maternity in the future.

Family Welfare Expenditure, Contraceptive Use, Sources and Method-Mix in India

Making universal access to sexual and reproductive health care a reality, and thus building momentum for comprehensive family planning by 2030, is key for achieving sustainable development goals. However, in the last decade, India has been retreating from progress achieved in access to family planning. Family planning progress for a large country such as India is critical for achieving sustainable developmental goals. Against this backdrop, the paper investigated the question of how far family welfare expenditure affects contraceptive use, sources of contraceptive methods, and method-mix using triangulation of micro and macro data analyses. Our findings suggest that, except for female sterilizations, modern methods of contraception do not show a positive relationship with family welfare expenditure. Notwithstanding a rise in overall family welfare expenditure, spending on core family planning programs stagnates. State-wise and socio-economic heterogeneity in source-mix and method-mix continued to influence contraceptive access in India. Method-mix continued to skew towards female sterilization. Public sector access is helpful only for promoting female sterilization. Thus, the source-mix for modern contraceptives presents a clear public-private divide. Over time, access to all contraceptive methods by public sources declined while the private sector has failed to fill the gap. In conclusion, this study identified a need for revitalizing family planning programs to promote spacing methods in relatively lower-performing states and socio-economic groups to increase overall contraceptive access and use in India through the rise in core family planning expenditure.

Trends in female sterilization in north central Nigeria

Background: Contraception is key to the reduction of maternal mortality. Tubal ligation is a good option for women seeking out a safe, effective, permanent and convenient form of contraceptive. However, due to variety of reasons, there is aversion to it especially in developing world. The objective of this study was to determine the trends, uptake, socio-demographic characteristics of acceptors, indications and complications of bilateral tubal ligation (BTL) in our environment.Methods: A retrospective study of BTL at UATH was conducted over a five year period, from 1 January 2015 to 31 December 2019. The records of women who had BTL were retrieved from the medical records department, family planning clinic, and the theatre. The data was analyzed using SPSS 21.Results: The mean age and parity were 36.0±4.0 and 5.0±2.0 respectively. The incidence of BTL was 1.3%. Majority of those that had BTL had at least secondary level of education 100 (83.4%) and 58 (48.3%) were grand multiparous. Majority of cases 87 (72.5%) were done during caesarean section/laparotomy. Postpartum BTL accounted for 15.0%, while interval BTL accounted for 12.5%. Completed family size was the commonest indication 48.3%. No client came back with regrets. There was one case of failed BTL.Conclusions: BTL is a safe and effective method of sterilization. There is an increasing trend in utilization of BTL however the rate is still low.

Factors explaining the dominion status of female sterilization in India over the past two decades (1992-2016): A multilevel study

Background Female sterilization is a permanent method of contraception practiced widely in India. Though, the important evidences of behavior of contraceptives is widespread in the literature, relatively less research has been conducted that explores particularly female sterilization method and how its behavior has remained dominant over the past two decades. The present study aims to examine how the level of women’s socio-demographic and fertility related characteristics intersect to shape the behavior for the dominance of female sterilization. Methods This study was based on pooled data from 1992–93, 1998–99, 2005–06 and 2015–16 India’s DHS (NFHS) surveys. The outcome variable of the study was different types of contraceptive methods used. Multinomial logistic model has been applied to examine the relationship between the dependent variable and the explanatory variables. The software STATA version14 has been used for the entire analysis. Result The result of this study clearly demonstrates the evidence of continuing sterilization dominance in the India’s family planning program. The choice of different types of contraceptive methods is influenced by the longstanding heterogeneity of population associated with religion and the caste system. Reliance over female sterilization was observed in almost all parts of the country with southern India being the leading zone. Women in the lowest wealth quintile, uneducated, higher parity, and less exposed to media were more likely to use sterilization as a method of birth control. Conclusion The study was successful in identifying the factors behind the excessive dependency on female sterilization and also highlights the weakness of family planning program to promote other useful modern methods over the past two decades.

Has the Use of Contraceptive Helped in Averting Births? An Analysis of Births Averted in 21 Major States of India

Background: In a highly populated country like India, family planning plays a major role in controlling population growth. Estimation of births averted helps in assessing the effectiveness of contraceptive methods. Since the 1950s, different strategies of family planning have been adopted to curb fertility rates by expanding the use of modern contraception among couples. As a result, there has been a steady increase in the users of family planning methods to curb their family sizes. However, there is variation in the adoption of contraceptive methods across the states. From earlier researches, it is established that the permanent modern methods like female sterilization, male sterilization, and IUCD are almost 100 percent effective methods to prevent pregnancy. This study, therefore, is a worthy attempt to estimate the births averted using modern contraception at present for Indian states with the help of the latest available data, by using the method suggested by Liu and others (2008)[11]. Results: The results of the analysis show that births averted were highest in Uttar Pradesh and Maharashtra. However, the percentage reduction in births by the contraceptive method is highest in Punjab indicating the effectiveness of modern contraception use. Conclusions: The analysis of births-averted estimation not only shows the state-level variations but also its significant impact on reducing TFR. Further, female sterilization has the highest prevalence rate among the contraceptive method and averting the highest number of births.

Prevalence of and factors associated with anaemia in women of reproductive age in Bangladesh, Maldives and Nepal: Evidence from nationally-representative survey data

Background Anaemia is a significant public health problem in most South-Asian countries, causing increased maternal and child mortality and morbidity. This study aimed to estimate the prevalence of and factors associated with anaemia in women of reproductive age in Bangladesh, Maldives, and Nepal. Methods We used the nationally-representative Demographic and Health Surveys Program data collected from women of reproductive age (15–49 years) in 2011 in Bangladesh (n = 5678), 2016 in Maldives (n = 6837), and 2016 in Nepal (n = 6419). Anaemia was categorized as mild (haemoglobin [Hb] of 10.0–10.9 g/dL for pregnant women and 11.0–11.9 g/dL for non-pregnant women), moderate (Hb of 7.0–9.9 g/dL for pregnant women and 8.0–10.9 g/dL for non-pregnant women), and severe (Hb <7.0 g/dL for pregnant women and <8.0 g/dL for non-pregnant women). Multinomial logistic regression analyses were used to identify factors associated with anaemia. Results The prevalence of anaemia was 41.8% in Bangladesh, 58.5% in Maldives, and 40.6% in Nepal. In Bangladesh, postpartum amenorrhoeic, non-educated, and pregnant women were more likely to have moderate/severe anaemia compared to women who were menopausal, had secondary education, and were not pregnant, respectively. In Maldives, residence in urban areas, underweight, having undergone female sterilization, current pregnancy, and menstruation in the last six weeks were associated with increased odds of moderate/severe anaemia. In Nepal, factors associated with increased odds of moderate/severe anaemia were having undergone female sterilization and current pregnancy. Conclusion Anaemia remains a significant public health issue among 15-49-year-old women in Bangladesh, Maldives, and Nepal, which requires urgent attention. Effective policies and programmes for the control and prevention of anaemia should take into account the unique factors associated with anaemia identified in each country. In all three countries, strategies for the prevention and control of anaemia should particularly focus on women who are pregnant, underweight, or have undergone sterilization.