Is Empowerment the Key to Solve India’s Method-Mix Problem? Associational Analysis of Permanent Methods of Contraception and Women’s Empowerment Using Multi-Level Modelling of Survey Data

Piyush Kumar, Sambodhi Research and Communication Pvt. Ltd.
Vikas Choudhry, Sambodhi Research and Communications

Introduction: India's fertility transition, driven by government-led promotion of permanent methods like female sterilization, contrasts with high-income countries where reversible contraceptives and socioeconomic factors influenced fertility decline. This study examines the association between women's empowerment and use of permanent contraceptive methods in India. Methods: Data from women between 15–49 years in India's National Family Health Surveys (2015–2016 and 2019–2021) were analyzed. Women's empowerment was assessed via attitudes toward wife-beating, household decision-making, and freedom of movement, creating an empowerment index. A multilevel regression examined the association between empowerment and permanent contraceptive use, controlling for demographic, economic, and social factors. Results: Higher women's empowerment was associated with a lower likelihood of using permanent contraceptive methods. Factors increasing permanent method use included older age, higher parity, rural residence, lower education, and belonging to marginalized groups. State and district-level clustering indicated that empowerment differences contribute to regional variations. Study Implications: Empowering women may lead to a preference for reversible contraceptives, enhancing reproductive autonomy. Indian family planning programs should integrate empowerment initiatives and address regional disparities to promote women-centered, rights-based care. Targeted interventions are needed to shift norms and expand contraceptive options where permanent methods predominate.

Keywords: Multi-level modeling , Sexual and Reproductive Health and Rights, Family Planning and Contraception, Fertility

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