Since the unmet need for contraception poses a significant health issue for currently married women in India, it is important to lay emphasis on the pattern and determinants associated with the use of contraception among women aged 15–24 years. Adequate policy measures leading to satisfactory use of effective contraception may shield this vulnerable age range (15–24) from unintended pregnancy, early motherhood, and high reproductive morbidity.
Our study has highlighted that the unmet need for contraception among currently married women aged 15–24 years was higher for spacing (14.12%) than for limiting (4.30%), with a total of 18.42%. The analysis from our study revealed important differences with respect to socioeconomic and demographic characteristics which played a significant role in the resulting unmet needs. It was found that unmet need was more likely to be higher among women of lower age groups, among those with no education, women from the poorest section, those hailing from rural areas and those with females as the head of their households. Additionally, unmet needs were reportedly higher among Muslim and Christian women, women from the Scheduled Caste (SC) and Other Backward Classes (OBC) and those who did not have the same fertility desires as their husbands. Determinants of unmet needs for spacing followed almost the same trend as the total unmet needs. However, for women with unmet needs for limiting, the needs were likely to increase with an increase in age. Rationally, the needs were lower among women with higher education and richer households.
As per the analysis, it was found that total unmet needs and needs for spacing decrease with the increase in the age group of women. Our results corroborate the previous studies conducted in India that show higher unmet needs in lower age groups (Yadav et al, 2020; Tapare et al, 2017; Pawar et al, 2020). Owing to low maturity, lesser knowledge about contraception and insignificant role in decision-making, younger women, especially in the vulnerable age group below 19 years are more susceptible to unmet needs (Kennedy et al, 2011). Our results found that younger adults (21–24 years) were less likely to have unmet needs for spacing but higher needs for limiting than adolescent women (15-17years). The intuition behind this might be that since such mothers were yet to achieve optimum fertility, as they age, they start to prefer spacing childbirth but fail to limit them (Wulifan et al, 2016). Ironically, despite the fact that spacing is the primary driver of young women's demand for family planning (Jansen, 2005), adolescent girls and women use contraception less frequently, have less awareness of family planning, and have less access to resources than adult women do (Kennedy et al., 2011). Past studies back up the idea that because younger women are sexually active and more eager to avoid pregnancy but are not using modern methods of contraception, they are more likely to have unmet needs for family planning (Ojakaa et al, 2008; Oginni et al., 2015). Thus, it is important to devise age-specific policies to bring down the prevalence of unmet needs, especially among young women.
The results show a higher likelihood of a decrease in total unmet needs, unmet needs for spacing and unmet needs for limiting attaining at least primary education. Similar findings have been previously reported by studies on the Indian population (Sherin et al, 2013; Hamsa et al, 2013; Yadav et al, 2020). Apart from India, similar results have been noted in other low-income countries as well. Unmet needs have been found to be lower among women with secondary or higher education in Uganda (Khan et al, 2008), while in Kenya, women with secondary education were twice less likely to experience unmet needs than those with education less than the secondary level (Wafula and Ikimari, 2007). Since health facilities are more accessible to educated women, they tend to be better informed about contraception, ultimately leading to a lower prevalence of unmet needs for contraception.
Our study detected a decline in the unmet need with the rise in the household's socioeconomic status. High unmet needs for limiting were seen among the poor household. Prior studies have also obtained similar results and cited the reason as, younger women from wealthy families may have easier access to modern contraception than those from poorer families, which is the most likely explanation (Ahinkorah et al., 2020; Mahapatro et al., 2021).
Women’s religion showed an increase in total unmet needs and unmet needs for spacing in the case of Muslims and Christians in comparison to Hindus. The results match previous studies where religion has a significant impact on the unmet needs of women (Vohra et al, 2014). Muslim women typically have less autonomy and are much more prone to not using contraception because of their poor socioeconomic conditions (Kumar & Singh, 2013; Srivastava et al., 2011).
The scheduled caste and OBC women were found to have a high unmet need for spacing, and the scheduled tribe women were found to have a high unmet need for limiting. Previous studies have also found that women belonging to the Scheduled Caste are at higher risk of meeting the contraceptive demand. Higher acceptability barriers relating to personal choices, attitudes and socioeconomic circumstances, which are apparent from descriptive studies, may be one of the causes of their greater unmet demand (Mahapatro et al., 2021; George, 2015).
Place of residence was found to be a highly significant factor while detecting unmet needs. It was seen that women residing in rural households had a high unmet need for spacing and limiting. Prior studies have also obtained similar results with respect to place of residence, where rural women experience high unmet needs compared to urban settings (Devi et al., 1995).
Households with female heads were found to have higher unmet needs in limiting and spacing in comparison to male household heads. A comparable finding was made in a study of Ethiopian women, where the findings showed that women living in families headed by women were less likely to use long-term contraceptives than women living in households headed by men (Fekadu et al., 2019).
A couple’s desire for children has emerged as a key influence of unmet needs in terms of limiting, spacing, and overall unmet needs. Unmet needs across all three stages were found to be less likely in the case of both the couples wanting the same number of children than the husband wanting more or fewer children or women ignoring their husband’s fertility intentions. Although previous studies have found unmet needs to be less likely for couples desiring the same number of children (Nzokirishaka & Itua, 2018; Mulenga et al, 2020), the aspect of high unmet need in case of the husband wanting fewer children remains to be explored.
Limitations
This study has not been without limitations. First, since this study has considered only phase 5 of the NFHS survey, owing to the cross-sectional nature of the data it was only possible to provide evidence of statistical associations between the dependent and independent variables. Hence, a causal relationship could not be established. Second, the study has majorly provided insights into unmet needs from a woman’s point of view. Since in a male dominant society like India, most family planning decisions are influenced by men, it is important to explore the man’s views of fertility and contraception.