Geographic and socioeconomic inequalities in the coverage of contraception in Uttar Pradesh, India

Abstract

Background: Uttar Pradesh (UP) is the most populous state in India, with a historically lower level of family planning coverage than the national average. In recent decades, family planning coverage in UP has significantly increased, yet there are considerable geographic and socio-economic inequalities.

Methods: The data used for the study is derived from a cross-sectional quantitative survey of 12,200 currently married women conducted during December 2020-February 2021 in UP by the Technical Support Unit. Univariate and bivariate analyses were performed and equiplots were used to make visualizing inequalities easy.

Results: The findings of the study reveal significant variation in family planning coverage indicators amongst currently married women in reproductive ages by administrative divisions in UP. For instance, in the Jhansi division, it was 72.4%, while in Faizabad, it was 39.3%. Jhansi division experienced the highest modern contraceptive coverage with the lowest inequity compared to other divisions. However, the range of coverage within the division by Accredited Social Health Activist (ASHA) areas is 25% to 75%. In fact, for some ASHA areas in the Jhansi division, the family planning demand satisfied for modern contraception ranged from more than 85% to less than 22%. On the other hand, the Gonda division with the lowest coverage and lowest inequity for demand satisfied for modern contraception has some ASHA areas with less than 5% and some with more than 36%. The study also revealed intersectionality of education, wealth, place of residence and geographic divisions in identifying inequity patterns. For instance, in case of Mirzapur and Varanasi, the demand satisfied among the illiterates was 69% and the corresponding percentage for literates was 49%. With respect to place of residence, Basti division, where the coverage for modern contraception is extremely low, demand satisfied for modern contraceptive methods is 16.3% among rural residents compared to 57.9% in the case of urban residents.

Conclusions: The findings showed inequality in the modern family planning methods coverage in UP in both best and worst performing divisions. The inequalities exist even in extremely small geographies such as ASHA areas. Within the geographies as well, the socio-economic inequalities persisted. These inequalities at multiple levels are important to consider for effective resource allocation and utilization.

Keywords: Administrative Divisions; Contraception; Coverage; Demand Met; Inequalities; Uttar Pradesh.

Fig. 1

Divisional level inequalities in family planning coverage indicators in Uttar Pradesh, India, 2021

Fig. 2

Distribution of divisional inequalities in demand satisfied by modern family planning methods in Uttar Pradesh, India, 2021 (The lines in the Y and X axes represent the median in the coverage (x axis) and the median values in the inequality measure (y axis))

Fig. 3

Distribution of within division inequalities in demand satisfied by modern contraception in Uttar Pradesh, India, 2021

Fig. 4

Distribution of within division inequalities in demand satisfied by modern contraception in selected divisions in Uttar Pradesh, India, 2021

Fig. 5

Divisional inequalities in family planning methods by education in Uttar Pradesh, India, 2021

Fig. 6

Divisional inequalities in family planning methods by income in Uttar Pradesh, India, 2021

Fig 7

Divisional inequalities in family planning methods by place of residence in Uttar Pradesh, India, 2021