1. Understanding patterns of temporary method use among urban Indian women Janine Barden-O’Fallon, MEASURE Evaluation PRH Lisa Calhoun, MLE Livia Montana, MLE Priya Nanda, MLE Ilene Speizer, MLE

2. Presentation Overview  Background  Research objectives  Data  Methods  Results  Limitations  Conclusions Photo by JHU-CCP

3. Background: Contraceptive use in India  CPR is 56% among currently married women –Sterilization is most common method (66% of use) –Condoms (9% of use) and rhythm (9% of use)  Temporary method users are more likely to be better educated and wealthier than sterilized women  One year discontinuation rate for temporary methods is high: condoms 45%, pills 49%, rhythm method 32% -All data from NFHS-3, 2005-06

4. Research Objectives  Examine differences in demographic characteristics and use patterns among temporary method users in urban Uttar Pradesh, India  Descriptive analysis using contraceptive data from a two year period

5. Measurement, Learning & Evaluation (MLE)  Evaluation of the Urban Reproductive Health Initiative (URHI): –5 year project funded by the Bill & Melinda Gates Foundation –Goal is to increase modern contraceptive use –Four countries: Senegal; Kenya; Nigeria; and Uttar Pradesh, India  Carolina Population Center (University of North Carolina, Chapel Hill) in partnership with International Center for Research on Women  http://www.urbanreproductivehealth.org/ http://www.urbanreproductivehealth.org/

6. Data for Analysis  Longitudinal surveys of women in 4 intervention cities: –Baseline (2010) - Representative sample of married women 15-49 with an oversample of slum populations (N=17,643) –Mid-term sub-sample (2012) - 85.8% response rate (N=5,790)  Contraceptive calendar used to collect month- by-month data on contraceptive use, non-use, reason for discontinuation, pregnancy and birth, for 2 year period between surveys

7. Methods  Construct meaningful categories of women based on patterns of contraceptive use during the calendar period  Descriptive comparison of socio-demographic characteristics, fertility desires, discontinuation and method switching, and pregnancy outcomes  Assess reasons for discontinuation by order of discontinuation during the calendar period

9. Results: Socio-demographic characteristics and fertility intentions No use (n=1,406) Sterilized during calendar (n=137) Condom (n=948) Traditional (n=977) Other modern (n=407) Multiple temporary methods (n=148) %%% 12+ yrs education 30.027.753.838.447.437.4 Wealthiest 15.914.528.020.824.921.9 Scheduled caste 23.930.316.123.616.121.3 Desire no more births 46.962.469.770.979.078.4 Slum 19.922.914.014.713.613.1

10. Results: Method use characteristics No use (n=1,406) Sterilized during calendar (n=137) Condom (n=948) Traditional (n=977) Other modern (n=407) Multiple temporary methods (n=148) Mean # months of use 013.2*22.923.321.021.9 Mean # discons 00.310.160.140.161.36 % >= 1 month of non-use 10077.536.633.944.055.2 * Use of sterilization only

11. Results: Mean number of pregnancies and terminations during 2 year period

12. Results: Reasons for discontinuation

14. Limitations  Potential for underreporting pregnancy and terminations  Potential for data heaping  Calendar may not be best measure of use for temporary methods most common in India

15. Conclusions  Identified a number of socio-demographic differences between temporary method users during a 2 year time period  Relatively high incidence of pregnancy and termination among multiple method users  Traditional method users vs. condom users  Discontinuation due to problems with the method persists and leads to questions about service quality

16. The Measurement, Learning & Evaluation (MLE) Project for the Urban Reproductive Health Initiative is funded by the Bill & Melinda Gates Foundation. The MLE project is implemented by the Carolina Population Center at the University of North Carolina at Chapel Hill, in partnership with International Center for Research on Women. The views expressed in this presentation do not necessarily reflect the Gates Foundation. THANK YOU