Bihar with High Sterilization Rate Still Grappling with Its High Fertility: A Spatial and Multi-Level Study

PRIYANKA YADAV, Institute of Economic Growth, Population Research Centre, Delhi, India.

Introduction: India's family planning initiatives, starting with the 1952 program, have highlighted a focus on female sterilization, which accounts for 36% of global cases. Despite progress, states like Bihar, with low overall contraceptive use and high sterilization rates, face challenges. The Sustainable Development Goals (SDGs) emphasize universal access to reproductive healthcare, including family planning, by 2030. Objectives: This study examines contraception use in Bihar, focusing on female sterilization and intrauterine devices (IUDs). Key objectives include analysing contraceptive methods over time, identifying factors influencing contraceptive behaviour at various levels, and pinpointing barriers to achieving targeted fertility rates. Method: Using National Family Health Survey-5 data (2019–21), the study analysed currently married women aged 15–49 who adopted sterilization recently (n = 42,483). Methods include descriptive analysis, spatial visualization, and multilevel logistic modelling. Result: Bihar, despite high sterilization rates (34.8%) and a high total fertility rate (TFR) of 3.0, showed trends of sterilization occurring at higher ages and after reaching higher parities. Policy Implication: Addressing disparities in health infrastructure and education is crucial. Comprehensive strategies must focus on improving family planning services, addressing social determinants of health, and integrating these efforts into broader development plans to meet SDG targets effectively.

Keywords: Family Planning and Contraception, Fertility, Multi-level modeling , Spatial Demography

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