The shift from natural to controlled fertility: a cross-sectional analysis of ten Indian states

Abstract

This study investigates the causes of the transition from natural to controlled fertility in India by comparing couples who have ever used contraception with those who remained under natural fertility conditions. Using sample study data this paper considers the relative effects of the factors involved in the shift to controlled fertility among ten early-transitional Indian States in 1970. The results indicate that it is primarily improvements in child mortality and its effects through intervening factors that account for the transition. The implication is that the success of a family planning program is largely a function of improvements in child health.

PIP: Mechanisms underlying the transition from natural to controlled fertility were investigated in India by comparing couples who were ever-users of contraception with those who remained under conditions of natural fertility. Data were derived from a 1970 all-India family planning survey of approximately 27,000 couples. The analysis was aimed at determining whether the contracepting subpopulation was distinguishable from the natural fertility subpopulation in terms of higher potential family size (as measured by fecundity and infant and child mortality), lower desired family size, family size composition, or more favorable attitudes toward and knowledge of fertility regulation. Overall, 76% of married women ages 35-44 years were under natural fertility conditions, with a range from 60% in Punjab to 88% in Uttar Pradesh. The states fell into 2 broad groupings with regard to the stage of the transition from natural to controlled fertility. On average, only 15% of women, in the early transition states of Andhra Pradesh, Rajasthan, Karnataka, Madhya Pradesh, and Uttar Pradesh had ever regulated their fertility. In contrast, an average of 36% of women in the more advanced states of Punjab, Maharashtra, Tamil Nadu, Kerala, and Gujarat had practiced fertility control. Nonetheless, the mean number of children ever born was 5.34 in both groups of states. Levels of surviving children were slightly higher in the more advanced states (4.25) than in states at an earlier stage (3.94). The contracepting subpopulation tended to experience significantly higher fertility, suggesting a more rapid pace of childbearing and higher child survivorship rates. In each state, child mortality was significantly higher among the natural fertility subpopulation than among regulators. These differences were especially marked in the early transition states. The pattern of the relationship between regulation and the other variables analyzed was essentially the same in both groups of states. Thus, this analysis suggests that it is primarily improvements in infant and child mortality that account for the adoption of fertility regulation. Improvements in child mortality result both in shorter intervals between living children and a situation of excess fertility, in turn motivating the transition to controlled fertility.