The impact of accredited social health activists in India on uptake of modern contraception: A nationally representative multilevel modelling study

Figures & data

Table 3. Multilevel logistic regression models of factors associated with current use of modern contraception among women in the study sample, India, NFHS-5, 2019–2021.

	Null Model			Baseline Model			Final Model
	OR	Lower 2.5%	Upper 2.5%	OR	Lower 2.5%	Upper 2.5%	OR	Lower 2.5%	Upper 2.5%
ASHA exposure (ref = no)							1.94***	1.83	2.06
Age (ref = 15-19)
20–24				0.75***	0.65	0.86	0.76***	0.66	0.87
25–29				0.47***	0.41	0.54	0.50***	0.43	0.58
30–34				0.24***	0.21	0.28	0.28***	0.24	0.32
35–39				0.10***	0.09	0.12	0.13***	0.11	0.15
40–44				0.03***	0.03	0.04	0.04***	0.04	0.05
45–49				0.02***	0.01	0.02	0.02***	0.02	0.03
Education (ref = no education)
Primary				1.17**	1.06	1.29	1.16**	1.05	1.29
Secondary				1.39***	1.28	1.50	1.36***	1.25	1.47
Higher				1.98***	1.78	2.21	1.94***	1.74	2.16
Marital status (ref = never married)
Married				4.09***	3.24	5.16	3.94***	3.12	4.98
Widowed/separated				0.16***	0.11	0.25	0.17***	0.11	0.25
Total children (ref = 0)
1				1.40***	1.21	1.63	1.10	0.95	1.28
2				2.45***	2.10	2.85	1.92***	1.65	2.24
3				3.59***	3.04	4.24	2.78***	2.35	3.28
4				4.63***	3.83	5.60	3.52***	2.91	4.26
5				5.67***	4.52	7.10	4.23***	3.37	5.30
6 or more				6.27***	4.86	8.09	4.63***	3.59	5.98
Ideal number of children (ref = 0)
1				1.14	0.94	1.39	1.14	0.93	1.38
2				1.19*	1.01	1.39	1.16	0.99	1.36
3				1.12	0.94	1.33	1.07	0.90	1.28
4				1.07	0.89	1.30	1.03	0.85	1.25
5				1.05	0.76	1.45	1.01	0.73	1.41
6 or more				1.03	0.65	1.62	0.98	0.62	1.56
missing				0.58*	0.35	0.96	0.57*	0.34	0.93
Living sons (ref = none)				1.01	0.95	1.09	1.04	0.97	1.12
Religion (ref = Hindu)
Muslim				0.95	0.86	1.04	0.94	0.85	1.03
Christian				0.64***	0.52	0.78	0.68***	0.56	0.83
Other				0.97	0.80	1.17	1.01	0.83	1.22
Caste (ref = none)
Scheduled Caste				1.09	0.99	1.20	1.07	0.97	1.18
Scheduled Tribe				1.07	0.95	1.19	1.02	0.91	1.14
Other Backward Caste				1.00	0.92	1.09	0.98	0.91	1.07
Don’t know				1.05	0.88	1.24	1.05	0.89	1.25
Wealth (ref = poorest)
Poorer				0.99	0.91	1.07	1.01	0.93	1.09
Middle				1.04	0.95	1.14	1.08	0.99	1.18
Richer				1.04	0.95	1.15	1.10*	1.00	1.21
Richest				1.18**	1.06	1.32	1.28***	1.15	1.43
Exposed to FP media (ref = no)				1.36***	1.27	1.46	1.30***	1.21	1.40
	Estimate	S.E.	p-value	Estimate	S.E.	p-value	Estimate	S.E.	p-value
Random effect (level-2 variance)	1.40	0.04	0.00	1.58	0.05	0.00	1.54	0.05	0.00
Variance partition coefficient (VPC)	35.53%			48.34%			45.40%
Model fit statistic (AIC)	103,955			90,390			89,499

*p < 0.05; **p < 0.01; ***p < 0.001.

Table 1. Percentage of women of reproductive age using contraception in India, NFHS-5, 2019–2021.

Method (%)	Overall sample (N = 724,115)	Married women (N = 512,408)	Study sample* (N = 185,427)	Study sample exposed to ASHAs* (N = 50,688)	Study sample not exposed to ASHAs* (N = 134,739)
Using any method	50.1	66.7	35.1	42.3	32.3
Using any modern method	42.7	56.4	8.8	15.6	6.1
Using a reversible modern method	13.4	18.2	6.9	12.3	4.8
Modern method users currently using:
Pill	8.6	9.0	15.4	15.5	15.3
IUD	3.6	3.7	6.7	6.7	6.7
Injections	0.9	1.0	3.9	3.7	4.2
Diaphragm	0.01	0.01	0.01	0	0.01
Male condom	16.5	16.8	42.2	38.8	45.6
Female sterilisation	68.1	67.2	20.9	20.7	21.1
Male sterilisation	0.5	0.5	0.1	0.1	0.2
Lactational amenorrhoea	1.3	1.3	10.2	14.2	6.1
Female condom	0.1	0.1	0.2	0.1	0.2
Foam or jelly	0.0	0.01	0.0	0.01	0.0
Emergency contraception	0.1	0.1	0.3	0.2	0.4
Standard days method (SDM)	0.3	0.3	0.1	0.1	0.02

*The study sample includes women aged 15–49 who are permanent residents of the household, fecund, not currently pregnant, do not want children, have previously had sexual intercourse, and started using their current method within the previous 4 months since the time of the interview. All reported sample sizes are unweighted and the %s are weighted.

Table 2. Socio-demographic characteristics of the study sample stratified by current use of a modern contraceptive method, India, 2019–2021.

		N (total)	% (total)	Stratified by current use of modern contraception
				No	%	Yes	%	p-value*
Exposed to ASHA	No	134,739	71.9	126,988	74.0	7,751	50.0	<.001
	Yes	50,688	28.1	43,052	26.0	7,636	50.0
Age	15–19	7,162	4.1	6,298	3.9	864	6.4	<.001
	20–24	28,363	15.8	23,852	14.4	4,511	30.2
	25–29	36,656	19.9	31,463	18.6	5,193	33.6
	30–34	30,246	16.0	27,502	15.9	2,744	17.4
	35–39	28,687	15.2	27,362	15.8	1,325	8.2
	40–44	25,843	13.7	25,340	14.7	503	2.8
	45–49	28,470	15.3	28,223	16.7	247	1.5
Education	No education	53,227	28.5	50,437	29.7	2,790	17.0	<.001
	Primary	24,563	12.9	22,765	13.1	1,798	11.5
	Secondary	85,685	45.0	77,413	44.2	8,272	52.9
	Higher	21,952	13.5	19,425	13.0	2,527	18.6
Marital Status	Not married	7,155	2.9	6,820	3.0	335	1.8	<.001
	Married	162,147	88.7	147,147	87.9	15,000	97.9
	Widowed/separated	16,125	8.4	16,073	9.1	52	0.3
Total Children	0	16,448	8.4	15,427	8.6	1,021	6.5	<.001
	1	43,812	25.1	39,748	24.9	4,064	27.5
	2	60,793	33.1	55,089	32.7	5,704	37.3
	3	33,485	17.2	30,730	17.2	2,755	17.2
	4	16,802	8.8	15,648	9.0	1,154	7.3
	5	7,802	4.1	7,370	4.2	432	2.7
	6 or more	6,285	3.2	6,028	3.4	257	1.5
Ideal number of children	0	7,972	4.2	7,546	4.4	426	2.9	<.001
	1	11,854	7.6	11,018	7.7	836	6.1
	2	107,856	61.8	97,705	61.2	10,151	68.4
	3	32,201	16.3	29,607	16.4	2,594	15.6
	4	17,958	7.7	16,852	7.9	1,106	5.8
	5	3,192	1.0	3,044	1.0	148	0.6
	6 or more	2,150	0.6	2,073	0.6	77	0.3
	missing	2,244	0.8	2,195	0.8	49	0.3
Living Sons	None	49,648	26.9	45,275	26.8	4373.0	28.5	<.001
	At least one son	135,779	73.1	124,765	73.2	11014.0	71.5
Religion	Hindu	131,867	78.6	120,139	78.4	11,728	80.4	<.001
	Muslim	25,922	16.1	23,725	16.2	2,197	15.7
	Christian	17,305	2.2	16,558	2.3	747	1.3
	Other	10,333	3.0	9,618	3.1	715	2.6
Caste	Scheduled caste	34,199	21.2	30,950	21.1	3,249	23.0	<.001
	Scheduled tribe	38,441	9.3	35,857	9.3	2,584	8.8
	Other Backward Caste	67,072	41.8	61,187	41.8	5,885	42.3
	None	34,518	21.4	31,723	21.5	2,795	20.0
	Don’t know	11,197	6.3	10,323	6.3	874	5.9
Household Wealth	Poorest	44,983	22.0	41,550	22.1	3,433	20.9	<.05
	Poorer	42,345	20.8	38,937	20.8	3,408	20.7
	Middle	36,144	19.3	32,976	13.2	3,168	20.2
	Richer	32,527	19.1	29,648	19.1	2,879	19.5
	Richest	29,428	18.8	26,929	18.8	2,499	18.6
Exposed to FP media	No	55,138	28.3	51,754	29.0	3,384	21.0	<.001
	Yes	130,289	71.7	118,286	71.0	12,003	79.0

*The p-value represents the significance of a chi-square test for categorical variables and a t-test for cont. variables, calculated with weighted data.

Data availability statement

The data that support the findings of this study are available from the DHS programme after submitting an application at https://dhsprogram.com/.