Contraceptive use and preferences of young married women in Kerala, India

Figures & data

Figure 1 Summary of the survey and participating women.

Table 1 Reproductive characteristics of married women

Characteristics	Mean (SD)	Range
Age at marriage (n=203)	21.3 (2.3)	16–28
Age at first child birth (n=157)	22.4 (2.24)	17–27
Age at most recent birth (if more than one child; n=47)	24.6 (1.67)	20–27
Characteristics	Frequency	%
Number of children
One	110	54.2
Two	41	20.2
More than two	6	3.0
None	46	22.7
Women currently pregnant*	32	15.8
Women’s opinion on ideal age difference between two children (n=203)
≤2 years	16	7.9
3–5 years	176	86.7
>5 years	11	5.4
Comfortable with the gap between childbirths (n=47)
Emotionally comfortable	42	89.4
Physically comfortable	43	93.5
Physically and emotionally comfortable	40	85.1
Either physically or emotionally uncomfortable or physically and emotionally uncomfortable	7	14.9

Note:

* Twenty-three women who had no children, seven women who had one child, and two women who had two children were pregnant at the time of interview.

Figure 2 Current use of contraceptive methods among 18–28-year-old married women in Trivandrum.

Abbreviations: CuT, copper T; IUD, intrauterine device.

Figure 3 Ever use of contraceptive methods among 18–28-year-old married women in Trivandrum.

Abbreviations: CuT, copper T; IUD, intrauterine device.

Table 2 Reasons for current nonuse of contraceptive methods

Reasons	For not using any contraceptive method (n=85)		For using only traditional method (not using any reversible method; n=47)
	Frequency*	%	Frequency	%
Trying to become pregnant	20	23.5
Husband’s disapproval	2	2.4
Not aware of how to use it	1	1.2
Now pregnant/recently delivered	44	51.8	3	6.4
Husband is abroad/sexual relation is rare	15	17.7	1	2.1
No interest/fear of side effects	26	30.6	43	91.5

Note:

* Multiple answers were possible.

Table 3 Factors affecting contraceptive use and decision on number of children – opinions of married women

Questions asked	Frequency*	%
In your opinion, what are the determinants of your contraceptive use?
Own decision	203	100.0
Husband’s decision	203	100.0
Perception regarding safety of the method	198	97.5
Recommended by doctor	91	44.8
Advertisements	34	16.8
In laws’ approval	5	2.5
Religious belief	3	1.5
Approval by friends	1	0.5
What are the factors affecting your decision on number of children?
Own health	136	67.0
Financial status	113	55.7
Desire for a son or daughter	33	16.3
Familial pressure	21	10.3
Ease of accessibility of family planning services	21	10.3
Social norms	3	1.5

Note:

* Multiple answers are possible.

Table 4 Preferred contraceptive method and reasons for preferring a particular method when the desired family size is complete

Methods preferred by married women (N=203)	Reasons
Female sterilization (tubal occlusion), n=185 (91%)	1. Safety and surety (n=149, 80.5%)
	2. It is the most common method/most aware of this method (n=64, 35%)
	3. No side effects (n=26, 14.1%)
	4. It can be done along with delivery/women can take rest along with delivery/men’s work will not get affected (n=23, 12.4%)
	5. Does not require follow-up/no need of going and buying each time/can save money (n=21, 11.4%)
	6. Husband is not willing/men will not agree/do not want husband to suffer (n=12, 6.5%)
	7. If a woman wants, it is possible to make her able to conceive again by a surgery (n=4, 2.2%)
Male sterilization (vasectomy), n=4 (2%)	1. “Men need little rest after vasectomy.”
	2. “Wife has to suffer the delivery pain, husband also need to know such worries. But I don’t know what my husband’s opinion is. Any way we will take a decision only after getting two children.”
	3. “I am feared to undergo any operation. So prefer to do vasectomy. I will take a decision only after discussing with my husband.”
	4. “Females are suffering many things like injection, medicines, and pain at the time of delivery. The males also will understand such things if vasectomy is preferred. It is the best thing a man can do for his wife.”
Female or male sterilization, n=2 (1%)	1. “I have some problems with my backbone, and now under treatment. So, the final decision will be depending on my health.”
	2. “If my husband is willing, I prefer vasectomy. Otherwise, I will undergo tubectomy.”
IUD, n=1 (0.5%)	1. “Sterilization is not permitted by our religion. CuT is safer than condom and there is no need to go to buy it regularly.”
Male condoms, n=2 (1%)	1. “I don’t want to suffer the difficulties while undergoing an operation. Condom is safe. If we use any other methods, we need to consult a doctor.”
	2. “Condoms will not make any risk; it has less chance of pregnancy.”
Natural methods, n=6 (3%)	1. “I have no trust in pills and condoms. Tubectomy is a surgery which cuts a part of our body. My husband is so bothered about my health and hence no interest with tubectomy or CuT.”
	2. “Pills have future side effects. CuT can make discomfort and infection.”
	3. “Feared to undergo operation.”
	4. “Withdrawal method has no side effects and also no need to undergo an operation. Also we are confident to follow this method without becoming pregnant.”
	5. “Stopping delivery is against our religious beliefs. But all females in my family and husband’s family did sterilization. But my husband may not allow me to undergo sterilization. Also he is not interested to use any other methods. So we prefer this.”
	6. “If anything happens to the current children there is no way to get more children in the future. So, withdrawal method may be the better. After stopping delivery, one had to prefer test tube babies [if a woman needs another baby after female sterilization, she has to undergo an in vitro fertilization (IVF) or the so called ‘prefer test tube babies’, which will be quite expensive and has no surety of success].”

Notes: For female sterilization, the number of women reporting a particular reason and its percentage is given. For other methods, the reasons reported by the women are listed because only a few women preferred those methods. The survey was conducted in Malayalam and the data entry operator translated the quotes to English and entered them in the computer, then the author verified all translations one by one and did the necessary editing and summarized them.

Abbreviation: IUD, intrauterine device.

Table 5 Sociodemographic characteristics vs current use and preference for contraception

Characteristics	Current usea
	Number of married women (N=203)	Female sterilization (n=27)	Any modern method other than female sterilization (n=44)	Any traditional method (n=77)	Any method (n=118)	Preferring female sterilization when family size is complete (n=185)
Age, years
18–24, n	78	2 (2.6)	16 (20.5)	29 (37.2)	37 (47.4)	74 (95.0)
25–28	125	25 (20)	28 (22.4)	48 (38.4)	81 (64.8)	111 (88.8)
p value		<0.001	0.751	0.862	0.015	0.139
Religion
Hindu	123	17 (13.8)	28 (22.8)	45 (36.6)	73 (59.4)	112 (91.1)
Muslim	36	5 (13.9)	7 (19.4)	15 (41.7)	22 (61.1)	32 (88.9)
Christian	44	5 (11.4)	9 (20.5)	17 (38.6)	23 (52.3)	41 (93.2)
p value		0.913	0.891	0.853	0.661	0.79
Type of ration card
APL	125	15 (12)	32 (25.6)	48 (38.4)	75 (60.0)	112 (89.6)
BPL	71	10 (14.1)	9 (12.7)	27 (38.0)	38 (53.5)	66 (93.0)
Nil	7	2 (28.6)	3 (42.9)	2 (28.6)	5 (71.4)	7 (100.0)
p value		0.441	0.041	0.873	0.520	0.512
Main activity
Housewives	151	21 (13.9)	29 (19.2)	55 (36.4)	86 (57.0)	142 (94.0)
Othersb	52	6 (11.5)	15 (28.9)	22 (42.3)	32 (61.5)	43 (82.7)
p value		0.664	0.146	0.451	0.563	0.013
Highest educational attainment
12 years or below	116	22 (19.0)	23 (19.8)	43 (37.1)	75 (64.7)	111 (95.7)
Highly educated women	87	5 (5.8)	21 (24.1)	34 (39.1)	43 (49.4)	74 (85.1)
p value		0.006	0.461	0.770	0.030	0.008

Notes: Data shown as n, n (%), or p value.

a Percentages are taken from row totals, chi-squared test is used to measure the association.

b Others: studying/working/job seeking/study completed/waiting to join for another course/study stopped/trainee/taking tuition, and so on.

Abbreviations: APL, above poverty line; BPL, below poverty line.