Hostname: page-component-586b7cd67f-gb8f7 Total loading time: 0 Render date: 2024-11-25T19:27:23.275Z Has data issue: false hasContentIssue false
  • English
  • Français

Is economic inequality in family planning in India associated with the private sector?

Published online by Cambridge University Press:  24 June 2019

Abhishek Kumar ,
Anrudh K. Jain ,
Kumudha Aruldas ,
Arupendra Mozumdar Open the ORCID record for Arupendra Mozumdar [Opens in a new window] ,
Ankita Shukla ,
Rajib Acharya ,
Faujdar Ram  and
Niranjan Saggurti
Abhishek Kumar*
Affiliation:
Population Council, New Delhi, India
Anrudh K. Jain
Affiliation:
Population Council, New York, USA
Kumudha Aruldas
Affiliation:
Population Council, New Delhi, India
Arupendra Mozumdar
Affiliation:
Population Council, New Delhi, India
Ankita Shukla
Affiliation:
Population Council, New Delhi, India
Rajib Acharya
Affiliation:
Population Council, New Delhi, India
Faujdar Ram
Affiliation:
International Institute for Population Sciences, Mumbai, India
Niranjan Saggurti
Affiliation:
Population Council, New Delhi, India
Get access Rights & Permissions [Opens in a new window]

Abstract

This study examined the pattern of economic disparity in the modern contraceptive prevalence rate (mCPR) among women receiving contraceptives from the public and private health sectors in India, using data from all four rounds of the National Family Health Survey conducted between 1992–93 and 2015–16. The mCPR was measured for currently married women aged 15–49 years. A concentration index was calculated and a pooled binary logistic regression analysis conducted to assess economic disparity (by household wealth quintiles) in modern contraceptive use between the public and private health sectors. The analyses were stratified by rural–urban place of residence. The results indicated that mCPR had increased in India over time. However, in 2015–16 only half of women – 48% (33% from the public sector, 12% from the private sector, 3% from other sources) – were using any modern contraceptive in India. Over time, the economic disparity in modern contraceptive use reduced across both public and private health sectors. However, the extent of the disparity was greater when women obtained the services from the private sector: the value of the concentration index for mCPR was 0.429 when obtained from the private sector and 0.133 when from the public sector in 2015–16. Multivariate analysis confirmed a similar pattern of the economic disparity across public and private sectors. Economic disparity in the mCPR has reduced considerably in India. While the economic disparity in 2015–16 was minimal among those accessing contraceptives from the public sector, it continued to exist among those receiving services from the private sector. While taking appropriate steps to plan and monitor private sector services for family planning, continued and increased engagement of public providers in the family planning programme in India is required to further reduce the economic disparity among those accessing contraceptive services from the private sector.

Keywords

Modern contraceptive usePublic–private sourceConcentration index
Type
Research Article
Information
Journal of Biosocial Science , Volume 52 , Issue 2 , March 2020 , pp. 248 - 259
Copyright
© Cambridge University Press 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Agha, S and Do, M (2008) Does an expansion in private sector contraceptive supply increase inequality in modern contraceptive use? Health Policy and Planning 23(6), 465–475.CrossRefGoogle ScholarPubMed
Bertrand, JT, Hardee, K, Magnani, RJ and Marcia, AA (1995) Access, quality of care and medical barriers in family planning programs. International Family Planning Perspectives 21, 64–69 & 74.CrossRefGoogle Scholar
Campbell, MN, Sahin-Hodoglugil, N and Potts, M (2006) Barriers to fertility regulation: a review of the literature. Studies in Family Planning 37, 87–98.CrossRefGoogle ScholarPubMed
Campbell, OMR, Benova, L, Macleod, D, et al. (2015) Who, What, Where: an analysis of private sector family planning provision in 57 low- and middle-income countries. Tropical Medicine and International Health 20, 1639–1656.CrossRefGoogle ScholarPubMed
Chalasani, S (2012) Understanding wealth-based inequalities in child health in India: a decomposition approach. Social Science & Medicine 75, 2160–2169.CrossRefGoogle ScholarPubMed
Chaurasia, AR (2014) Contraceptive use in india: a data mining approach. International Journal of Population Research 2014, 821436.CrossRefGoogle Scholar
Ciszewski, RL and Harvey, PD (1995) Contraceptive price changes: the impact on sales in Bangladesh. International Family Planning Perspectives 21, 150–154.CrossRefGoogle Scholar
Creanga, AA, Gillespie, D, Karklins, S and Tsui, AO (2011) Low use of contraception among poor women in Africa: an equity issue. Bulletin of the World Health Organization 89, 258–266.CrossRefGoogle ScholarPubMed
Derek, O, Amy, C and Farooq, U (2015) Universal sustainable development goals: understanding the transformational challenge for developed countries. URL: https://sustainabledevelopment.un.org/content/documents/1684SF_-_SDG_Universality_Report_-_May_2015.pdf.Google Scholar
Filmer, D and Pritchett, LH (2001) Estimating wealth effects without expenditure data– or tears: an application to educational enrolments in states of India. Demography 38, 115–132.Google ScholarPubMed
Gakidou, E and Vayena, E (2007) Use of modern contraception by the poor is falling behind. PLoS Medicine 4, e31.CrossRefGoogle ScholarPubMed
Gillespie, D, Ahmed, S, Tsui, A and Radloff, S (2007) Unwanted fertility among the poor: an inequity? Bulletin of the World Health Organization 85, 100–107.CrossRefGoogle Scholar
Gwatkin, DR, Rutstein, S, Johnson, K, et al. (2007) Socio-Economic Differences in Health, Nutrition, and Population within Developing Countries: An Overview. Country reports on HNP and poverty. World Bank, Washington, DC.Google Scholar
Hamid, S and Stephenson, R (2006) Provider and health facility influences on contraceptive adoption in urban Pakistan. International Family Planning Perspectives 32, 71–78.CrossRefGoogle ScholarPubMed
Harvey, PD (1994) The impact of condom prices on sales in social marketing programs. Studies in Family Planning 25, 52–58.CrossRefGoogle ScholarPubMed
Hotchkiss, DR, Godha, D and Do, M (2011) Effect of an expansion in private sector provision of contraceptive supplies on horizontal inequity in modern contraceptive use: evidence from Africa and Asia. International Journal for Equity in Health 10, 33.CrossRefGoogle ScholarPubMed
Hutchinson, PL, Do, M and Agha, S (2011) Measuring client satisfaction and the quality of family planning services: a comparative analysis of public and private health facilities in Tanzania, Kenya and Ghana. BMC Health Services Research 11, 203.CrossRefGoogle ScholarPubMed
IIPS (2010) District Level Household and Facility Survey (DLHS-3), 2007–08. International Institute for Population Sciences, India.Google Scholar
IIPS and ICF (2017) National Family Health Survey (NFHS-4), 2015–16: India. International Institute for Population Sciences, Mumbai, India.Google Scholar
IIPS and ORC Macro (1995) National Family Health Survey (NFHS-1), 1992–93: India. International Institute for Population Sciences, Mumbai, India.Google Scholar
IIPS and ORC Macro (2000) National Family Health Survey (NFHS-2), 1998–99: India. International Institute for Population Sciences, Mumbai, India.Google Scholar
IIPS and ORC Macro (2007) National Family Health Survey (NFHS-3), 2005–06: India, Vol.1. International Institute for Population Sciences, Mumbai, India.Google Scholar
Jain, AK (1989) Fertility reduction and the quality of family-planning services. Studies in Family Planning 20, 1–16.CrossRefGoogle ScholarPubMed
Jain, AK and Bruce, J (1994) A reproductive health approach to the objectives and assessment of family planning programs. In Sen, G, Germaine, A, and Chen, LC (eds) Population Policies Reconsidered: Health Empowerment and Rights. Harvard University Press, Boston, pp. 92–211.Google Scholar
Jain, ML, Chauhan, M and Talwar, B (2016) Role of private sector in family planning program in Rajasthan, India– a rapid assessment. International Journal of Community Medicine and Public Health 3, 869–874.CrossRefGoogle Scholar
Jensen, ER, Kak, N, Satjawinata, K, Wirawan, DD and Nangoy, N (1994) Contraceptive pricing and prevalence: family planning self-sufficiency in Indonesia. International Journal of Health Planning and Management 9, 349–359.CrossRefGoogle ScholarPubMed
Karen, F, Karra, M and Pandit-Rajani, T (2010) Disentangling the Effects of Poverty and Place of Residence for Strategic Planning. Futures Group Health Policy Initiative, Task Order 1, Washington, DC.Google Scholar
Keesara, RS, Pamela, AJ and Cynthia, CH (2015) Why do women choose private over public facilities for family planning services? A qualitative study of post-partum women in an informal urban settlement in Kenya. BMC Health Services Research 15, 335.CrossRefGoogle Scholar
Kumar, A, Kumari, D and Singh, A (2014) Increasing socioeconomic inequality in childhood undernutrition in urban India: trends between 1992–93, 1998–99 and 2005–06. Health Policy and Planning 30(8), 1003–1016.CrossRefGoogle ScholarPubMed
Levin, A, Amin, A and Rahman, A, et al. (1999) Cost-effectiveness of family planning and maternal health service delivery strategies in rural Bangladesh. International Journal of Health Planning and Management 14, 219–233.3.0.CO;2-N>CrossRefGoogle ScholarPubMed
Mehata, S, Paudel, Y, Dotel, B, et al. (2014) Inequalities in the use of family planning in rural Nepal. BioMed Research International. Article ID 636439. URL: http://dx.doi.org/10.1155/2014/636439.CrossRefGoogle Scholar
Mohanty, SK (2012) Multiple deprivation and maternal care in India. International Perspectives on Sexual and Reproductive Health 38, 6–14.CrossRefGoogle ScholarPubMed
Mohanty, SK and Pathak, PK (2009) Rich–poor gap in utilization of reproductive and child health services in India, 1992–2005. Journal of Biosocial Science 41, 381–398.CrossRefGoogle Scholar
MOHFW (1996) Target-Free Approach in Family Welfare Program. Ministry of Health and Family Welfare, Government of India, New Delhi.Google Scholar
MOHFW (2000) National Population Policy. Ministry of Health and Family Welfare. Government of India, New Delhi.Google Scholar
MOHFW (2016) Annual Report 2015–16. Department of Health and Family Welfare, Ministry of Health and Family Welfare, Government of India, New Delhi.Google Scholar
Montgomery, MR, Gragnolati, M, Burke, KA and Paredes, E (2000) Measuring living standards with proxy variables. Demography 37, 155–174.CrossRefGoogle ScholarPubMed
O’Donnell, O, Doorslaer, EV, Wagstaff, A and Lindelow, M (2008) Analyzing Health Equity Using Household Survey Data: A Guide to Techniques and their Implementation. World Bank, Washington, DC.Google Scholar
Pachauri, S (1996) A shift from family planning to reproductive health: new challenges. In: Srinivasan, K (ed.) Population Policy and Reproductive Health. Population Foundation of India, New Delhi.Google Scholar
Pachauri, S (2014) Priority strategies for India’s family planning programme. Indian Journal of Medical Research 140, S137–S146.Google ScholarPubMed
Pathak, PK, Singh, A and Subramanian, S (2010) Economic inequalities in maternal health care: prenatal care and skilled birth attendance in India, 1992–2006. PLoS One 5, e13593.CrossRefGoogle Scholar
RamaRao, S, Lacuesta, M, Costello, M, Pangolibay, B and Jones, H (2003) The link between quality of care and contraceptive use. International Family Planning Perspectives 29, 76–83.CrossRefGoogle ScholarPubMed
Rosen, JE and Conly, S (1999) Getting Down to Business: Expanding the Private Commercial Sector’s Role in Meeting Reproductive Health Needs. Population Action International, Washington, DC.Google Scholar
Rutstein, SO and Johnson, K (2004) The DHS Wealth Index. DHS Comparative Reports No. 6. ORC Macro, Measure DHS, Calverton, MD.Google Scholar
Singh, A, Padmadas, SS, Mishra, US, et al. (2012) Socio-economic inequalities in the use of postnatal care in India. PLoS One 7, e37037.CrossRefGoogle ScholarPubMed
Singh, S, Shekhar, C, Acharya, R, et al. (2018) The incidence of abortion and unintended pregnancy in India, 2015. Lancet Global Health 6, e111–e120.CrossRefGoogle Scholar
Thyagarajan, S, Reji, B and Viswan, SP (2014) Determinants of contraceptive usage in India. International Journal of Interdisciplinary and Multidisciplinary Studies 1, 88–97.Google Scholar
UNFPA (2012) A Decade of Change in Contraceptive Use in Ethiopia. UNFPA, New York.Google Scholar
Valekar, S, Chawla, P, Tukaram, H, Fernandez, K and Kalra, K (2017) The socio-demographic determinants of contraceptive use among rural women in reproductive age group. Journal of Women’s Health Care 6, 355.Google Scholar
Vyas, S and Kumaranayake, L (2006) Constructing socio-economic status indices: how to use principal components analysis. Health Policy and Planning 21, 459–468.CrossRefGoogle ScholarPubMed
Wagstaff, A and Doorslaer, VE (2004) Overall versus socioeconomic health inequality: a measurement framework and two empirical illustrations. Health Economics 13, 297–301.CrossRefGoogle ScholarPubMed