Intrahousehold influence on contraceptive use among married Indian women: Evidence from the National Family Health Survey 2015-16.

BACKGROUND: India, where more than one married woman of reproductive age often live in the same household, provides an ideal setting to promote family planning through intrahousehold influence. OBJECTIVES: This study examined the association between use of modern contraceptives by young married women, and other married women live in the same household. METHODS: We included 31,361 currently married women of 15-24 years from women data of the National Family Health Survey 2015-16. Each of these women was living with another married woman within the same household, who was also interviewed. From each household, we labeled the woman with the shortest marital duration as the Index Woman. The second woman in each household was either labeled as Peer or Other or Elderly (had married within 5 years or 5-19 years after or 20 or more years after the marriage of Index women, respectively). The association between use of modern contraceptives by Index Women and the second woman in household was examined using logistic regressions-controlled for the background characteristics of Index Women. RESULTS: Index Women had 2.9 times adjusted odds (95%CI 2.5-3.3) of using modern contraceptives if living with Peers, who were also using modern contraceptives. Similarly, when the second women using modern contraceptives, an Index Woman had 1.7 times adjusted odds for using modern contraceptives (95%CI 1.5-1.9) if living with Elderly, and about 2.5 times adjusted odds if living with Other women (95%CI 2.1-2.8). The association between contraceptive use by an Index Woman and the second woman in the household remained significant even after controlling for background characteristics, showing the independent effect of intrahousehold influence on contraceptive use. CONCLUSION: The conclusive evidence of positive intrahousehold influence on contraceptive use of Index Women will encourage program managers to promote intrahousehold communication to increase use of family planning.

India's family planning market and opportunities for the private sector: An analysis using the total market approach.

The private (commercial) sector in India can complement public sector for family planning services, but the roadmap to engage these two sectors remains a challenge. The total market approach (TMA) offers a strategy by understanding the comparative advantage of public, commercial, and nonprofit sectors. We estimated TMA indicators using data of four rounds of the National Family Health Surveys: 1992-93, 1998-99, 2005-06, and 2015-16. The contraceptive prevalence of modern methods in India did not increase in recent years, but the number of users increased, and so did the market size for the commercial sector. In rural areas, the current market size in 2015-16 (75 million) failed to reach its potential size in 1992-93 (84 million). In urban areas, the market of modern contraceptives is mostly composed of the users from higher wealth, and a high percentage of users obtain contraceptives from subsidized sources. The family planning market of northern part of Bihar and Uttar Pradesh and of Northeast India are in the "early" stage and need more demand generation; "matured" markets are mostly concentrated in and around big metros. Subsidization in urban areas should be offered to the targeted population who need family planning products and services at low cost.

Increasing knowledge of home based maternal and newborn care using self-help groups: Evidence from rural Uttar Pradesh, India.

BACKGROUND: In India, pregnant women and recently delivered mothers of marginalized communities in Uttar Pradesh (UP) remain un-reached by frontline-health-workers. In these communities, self-help groups (SHGs) have the potential to reach these women with knowledge of home-based maternal and newborn care (HBMNC). OBJECTIVE: The study examines the feasibility of SHGs to improve knowledge of HBMNC. The study identifies the facilitating factors and barriers to knowledge change. METHODS: A panel study with a quasi-experimental design was conducted in Jhansi, UP. Peer educators, called Swasthya Sakhi, of the SHGs of the experimental area were trained on how to conduct discussions on HBMNC topics. Both at baseline and endline 233 women from the experimental area and 237 women from the comparison area were interviewed to measure their knowledge change in HBMNC topics. The net-effect of the intervention was examined using difference-in-difference (DID) analysis with propensity-score-matching (PSM) controlling for the effect of background characteristics of the participants from two study areas. Generalized-estimating-equation (GEE) was used to identify the facilitating factors and barriers to the knowledge change. RESULTS: The findings show significant net-increases in women's knowledge for most of the HBMNC topics including danger signs for a pregnant mother and a newborn child, even after controlling for the background characteristics of the participants. The most significant determinant of the increase of knowledge was the women's education. CONCLUSION: Findings from the study showed SHGs can increase HBMNC knowledge among women. However, studies with longer duration are required to examine the scalability and sustainability of the intervention.

Mobile Phone Messaging to Husbands to Improve Maternal and Child Health Behavior in India.

Over 90% of households in rural Uttar Pradesh, the most populous state of India, have at least one mobile phone. However, ownership of mobile phone among women is quite low. Implementation research was conducted in Uttar Pradesh to examine (a) whether providing information on selected maternal and child health (MCH) behaviors to a husband's mobile phone would enhance the man's knowledge and lead to discussions in their family, and (b) whether such discussions would help in the adoption of healthy practices. The m-Health intervention included biweekly voice messages in local language (Hindi) on MCH topics to the mobile phone of pregnant women's husbands. Using a quasi-experimental design, after four months of the m-Health intervention, in 2014, 881 husbands and 956 women from the study area were interviewed. Husbands' knowledge, controlling for their socio-demographic characteristics, were significantly higher among the listeners of the messages than the non-listeners. Multivariate logistic regression analysis showed that if husbands discussed the messages with family members, the odds of wives' practicing health behaviors improved significantly for three behaviors. These include one antenatal checkup in last trimester of pregnancy (odds ratio 1.72, p < 0.05), receiving a postnatal checkup within 7 days of delivery (odds ratio 3.02, p < 0.05), and delayed bathing of newborn (odds ratio 1.93, p < 0.05). Thus, communicating messages using m-Health was found to be an effective intervention for behavior change. The study demonstrated that mobile phones can be used effectively to reach men with MCH information and encourage them to promote healthy behavior in their family.